Provider Demographics
NPI:1497033567
Name:BOLTON, KRISTA C (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:C
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 POLARIS PKWY
Mailing Address - Street 2:T-1236
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2041
Mailing Address - Country:US
Mailing Address - Phone:614-430-5596
Mailing Address - Fax:614-430-5596
Practice Address - Street 1:1485 POLARIS PKWY
Practice Address - Street 2:T-1236
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2041
Practice Address - Country:US
Practice Address - Phone:614-430-5596
Practice Address - Fax:614-430-5596
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist