Provider Demographics
NPI:1437730751
Name:HANZEL, KRISTA NICOLE
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:HANZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1963
Mailing Address - Country:US
Mailing Address - Phone:330-725-4104
Mailing Address - Fax:
Practice Address - Street 1:207 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1963
Practice Address - Country:US
Practice Address - Phone:330-725-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09201597183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician