Provider Demographics
NPI:1558682625
Name:ANDERLE, KRISTI LOUISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LOUISE
Last Name:ANDERLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LOUISE
Other - Last Name:GLUECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5752 FM 532
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:TX
Mailing Address - Zip Code:77975-4690
Mailing Address - Country:US
Mailing Address - Phone:361-596-4838
Mailing Address - Fax:
Practice Address - Street 1:104 N HASLER BLVD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3740
Practice Address - Country:US
Practice Address - Phone:512-321-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39955183500000X
MO2001004308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist