Provider Demographics
NPI:1629378526
Name:KRISTENSEN, KATARZYNA REGINA (BSC PHARM)
Entity Type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:REGINA
Last Name:KRISTENSEN
Suffix:
Gender:F
Credentials:BSC PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2346
Mailing Address - Country:US
Mailing Address - Phone:425-339-9448
Mailing Address - Fax:425-258-2772
Practice Address - Street 1:1715 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2346
Practice Address - Country:US
Practice Address - Phone:425-339-9448
Practice Address - Fax:425-258-2772
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist