Provider Demographics
NPI:1841565850
Name:EASTMAN, KRISTINE L (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W DIMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1453
Mailing Address - Country:US
Mailing Address - Phone:907-267-6733
Mailing Address - Fax:907-267-6739
Practice Address - Street 1:2000 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1453
Practice Address - Country:US
Practice Address - Phone:907-267-6733
Practice Address - Fax:907-267-6739
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1630183500000X
AZS011626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist