Provider Demographics
NPI:1619579539
Name:KILBRETH, KRISTEN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KILBRETH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MAST RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-1163
Mailing Address - Country:US
Mailing Address - Phone:603-626-4366
Mailing Address - Fax:
Practice Address - Street 1:605 MAST RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-1163
Practice Address - Country:US
Practice Address - Phone:603-626-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty