Provider Demographics
NPI:1477025443
Name:FERRIS-THOMPSON, KRISTIN CHARLENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:CHARLENE
Last Name:FERRIS-THOMPSON
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 1:28170 785TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKS GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:56016-4096
Mailing Address - Country:US
Mailing Address - Phone:507-383-7497
Mailing Address - Fax:
Practice Address - Street 1:404 W FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2437
Practice Address - Country:US
Practice Address - Phone:507-377-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist