Provider Demographics
NPI:1679048862
Name:FRIES, KRISTA LAVERNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:LAVERNE
Last Name:FRIES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4389 BEAUFORT RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28533
Mailing Address - Country:US
Mailing Address - Phone:252-466-0170
Mailing Address - Fax:252-466-0382
Practice Address - Street 1:4389 BEAUFORT RD
Practice Address - Street 2:
Practice Address - City:MCAS CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533-0023
Practice Address - Country:US
Practice Address - Phone:252-466-0170
Practice Address - Fax:252-466-0382
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175611835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist