Provider Demographics
NPI:1821689779
Name:HASLETT, KRISTEN AMELIA
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AMELIA
Last Name:HASLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3161
Mailing Address - Country:US
Mailing Address - Phone:440-842-6081
Mailing Address - Fax:
Practice Address - Street 1:5812 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3161
Practice Address - Country:US
Practice Address - Phone:440-842-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist