Provider Demographics
NPI:1629321252
Name:GARCIA, KRISTEN M (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W JACKSON BLVD
Mailing Address - Street 2:T-2781
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2905
Mailing Address - Country:US
Mailing Address - Phone:312-279-3341
Mailing Address - Fax:
Practice Address - Street 1:1101 W JACKSON BLVD
Practice Address - Street 2:T-2781
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2905
Practice Address - Country:US
Practice Address - Phone:312-279-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist