Provider Demographics
NPI:1760777924
Name:TABOADA, KRISTY ANN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:ANN
Last Name:TABOADA
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 1:200 UNIVERSAL DR N
Mailing Address - Street 2:T-1916
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3156
Mailing Address - Country:US
Mailing Address - Phone:203-859-3491
Mailing Address - Fax:203-859-3491
Practice Address - Street 1:200 UNIVERSAL DR N
Practice Address - Street 2:T-1916
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3156
Practice Address - Country:US
Practice Address - Phone:203-859-3491
Practice Address - Fax:203-859-3491
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist