Provider Demographics
NPI:1477709368
Name:ELLIOTT, KRISTEN MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:ELLIOTT
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 1:915 N GRAND AVENUE
Mailing Address - Street 2:JOHN COCHRAN VA MEDICAL CENTER PHARMACY
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:JOHN COCHRAN VA MEDICAL CENTER PHARMACY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH 023786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist