Provider Demographics
NPI:1801180179
Name:LEPORE, KRISTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LEPORE
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 1:3020 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8333
Mailing Address - Country:US
Mailing Address - Phone:630-554-4005
Mailing Address - Fax:630-554-4005
Practice Address - Street 1:3020 ROUTE 34
Practice Address - Street 2:T1402
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8333
Practice Address - Country:US
Practice Address - Phone:630-554-4005
Practice Address - Fax:630-554-4005
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist