Provider Demographics
NPI:1619689130
Name:CRUZ, KRISTYN JOY TAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:KRISTYN JOY
Middle Name:TAN
Last Name:CRUZ
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 1:2623 SW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2446
Mailing Address - Country:US
Mailing Address - Phone:954-487-0441
Mailing Address - Fax:
Practice Address - Street 1:2623 SW 188TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2446
Practice Address - Country:US
Practice Address - Phone:954-487-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist