Provider Demographics
NPI:1679173124
Name:HEBERT, KRISTINA (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:HEBERT
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 1:2039 E 1100 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:OWANECO
Mailing Address - State:IL
Mailing Address - Zip Code:62555-5558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2607 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1235
Practice Address - Country:US
Practice Address - Phone:217-774-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist