Provider Demographics
NPI:1518383330
Name:GREEN, KRISTEN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1023 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3336
Mailing Address - Country:US
Mailing Address - Phone:320-632-1639
Mailing Address - Fax:
Practice Address - Street 1:1023 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3336
Practice Address - Country:US
Practice Address - Phone:320-632-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist