Provider Demographics
NPI:1629684253
Name:WEBB, KRISTEN SELLERS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SELLERS
Last Name:WEBB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2151
Mailing Address - Country:US
Mailing Address - Phone:601-575-3283
Mailing Address - Fax:
Practice Address - Street 1:12356 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-3700
Practice Address - Country:US
Practice Address - Phone:662-779-0119
Practice Address - Fax:662-779-0126
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-117911835P1300X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE-11791OtherMISSISSIPPI BOARD OF PHARMACY