Provider Demographics
NPI:1598308165
Name:GITTER, KRISTEN JEAN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEAN
Last Name:GITTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:JEAN
Other - Last Name:GITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KRISTEN SCHNEIDER
Mailing Address - Street 1:2342 FIELD STONE DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1920
Mailing Address - Country:US
Mailing Address - Phone:651-216-4503
Mailing Address - Fax:
Practice Address - Street 1:1940 CLIFF LAKE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2492
Practice Address - Country:US
Practice Address - Phone:651-454-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist