Provider Demographics
NPI:1578150504
Name:NOLAN, KRISTEN ALYSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALYSON
Last Name:NOLAN
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 1:865 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1847
Mailing Address - Country:US
Mailing Address - Phone:574-936-7334
Mailing Address - Fax:
Practice Address - Street 1:865 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1847
Practice Address - Country:US
Practice Address - Phone:574-936-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023706A183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist