Provider Demographics
NPI:1790922763
Name:ENGELEN, KRISTEN A (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:ENGELEN
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 1:1211 1ST AVE N STE 204
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1567
Mailing Address - Country:US
Mailing Address - Phone:866-234-4974
Mailing Address - Fax:
Practice Address - Street 1:1211 1ST AVE N STE 204
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1567
Practice Address - Country:US
Practice Address - Phone:866-234-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19803183500000X
FLPS501111835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care