Provider Demographics
NPI:1760867238
Name:BACKE, KRISTEN E (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:BACKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12445 ALAMEDA TRACE CIR
Mailing Address - Street 2:823
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12445 ALAMEDA TRACE CIR
Practice Address - Street 2:823
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6390
Practice Address - Country:US
Practice Address - Phone:847-668-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist