Provider Demographics
NPI:1578151015
Name:DUPREE, KRISTINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:DUPREE
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 1:550 ALGER CCC RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8138
Mailing Address - Country:US
Mailing Address - Phone:360-770-5185
Mailing Address - Fax:
Practice Address - Street 1:320 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1035
Practice Address - Country:US
Practice Address - Phone:360-855-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00060094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00060094OtherPHARMACY LICENSE