Provider Demographics
NPI:1467824060
Name:PEETOOM, CRISTIN (RPH)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:PEETOOM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:ESTELLE
Other - Last Name:GADDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2022 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-8151
Mailing Address - Country:US
Mailing Address - Phone:620-326-3321
Mailing Address - Fax:620-326-8012
Practice Address - Street 1:2022 E 16TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-8151
Practice Address - Country:US
Practice Address - Phone:620-326-3321
Practice Address - Fax:620-326-8012
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist