Provider Demographics
NPI:1760759377
Name:MCCORMICK, KRISTEN APPLEBY
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:APPLEBY
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6316
Mailing Address - Country:US
Mailing Address - Phone:954-689-0663
Mailing Address - Fax:
Practice Address - Street 1:11105 STIRLING RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-6316
Practice Address - Country:US
Practice Address - Phone:954-689-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist