Provider Demographics
NPI:1598531311
Name:TELHAMI, KRISTINA ELAINE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ELAINE
Last Name:TELHAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17836 GLEN HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8829
Mailing Address - Country:US
Mailing Address - Phone:510-875-9967
Mailing Address - Fax:
Practice Address - Street 1:17836 GLEN HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-8829
Practice Address - Country:US
Practice Address - Phone:510-875-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist