Provider Demographics
NPI:1477842227
Name:SHRIVER, KRISTY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANN
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HOLACRE DR
Mailing Address - Street 2:
Mailing Address - City:BETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44815
Mailing Address - Country:US
Mailing Address - Phone:419-986-5435
Mailing Address - Fax:
Practice Address - Street 1:103 HOLACRE DR
Practice Address - Street 2:
Practice Address - City:BETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44815
Practice Address - Country:US
Practice Address - Phone:419-986-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-19355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist