Provider Demographics
NPI:1578900569
Name:GASCOYNE, KRISTIN CHARYL KIESER (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:CHARYL KIESER
Last Name:GASCOYNE
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 NORTHRUP ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3727
Mailing Address - Country:US
Mailing Address - Phone:408-298-3020
Mailing Address - Fax:408-298-3020
Practice Address - Street 1:933 NORTHRUP ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3727
Practice Address - Country:US
Practice Address - Phone:408-298-3020
Practice Address - Fax:408-298-3020
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42172183500000X
VA23801835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2380OtherCGP
IL345238OtherNABP
CA42172OtherRPH