Provider Demographics
NPI:1679661268
Name:PELLINGRA, KRISTEN M (PHARMD, BCPS, BCPP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:PELLINGRA
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 E SABIN DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6197
Mailing Address - Country:US
Mailing Address - Phone:520-792-1450
Mailing Address - Fax:520-368-5794
Practice Address - Street 1:3601 S 6TH AVE # 13-119
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:520-629-1864
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00065741183500000X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy