Provider Demographics
NPI:1699369736
Name:ROSS, KRISTA MICHAEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MICHAEL
Last Name:ROSS
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:P.O. BOX 1778
Mailing Address - Street 2:
Mailing Address - City:GLASOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-1778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 HAPPY VALLEY RD.
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1537
Practice Address - Country:US
Practice Address - Phone:270-651-8359
Practice Address - Fax:270-361-5079
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist