Provider Demographics
NPI:1801215637
Name:SELF, KRISTINA RABON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:RABON
Last Name:SELF
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 1:970 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1662
Mailing Address - Country:US
Mailing Address - Phone:803-684-5282
Mailing Address - Fax:803-684-5854
Practice Address - Street 1:970 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1662
Practice Address - Country:US
Practice Address - Phone:803-684-5282
Practice Address - Fax:803-684-5854
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist