Provider Demographics
NPI:1467909192
Name:CARRERO, KRISTINA JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JEAN
Last Name:CARRERO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 FERRELL PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8867
Mailing Address - Country:US
Mailing Address - Phone:757-495-3088
Mailing Address - Fax:757-495-6581
Practice Address - Street 1:5036 FERRELL PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-8867
Practice Address - Country:US
Practice Address - Phone:757-495-3088
Practice Address - Fax:757-495-6581
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist