Provider Demographics
NPI:1851678221
Name:HA, KRISTINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HA
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 1:6401 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1118
Mailing Address - Country:US
Mailing Address - Phone:702-259-7002
Mailing Address - Fax:702-259-7003
Practice Address - Street 1:6401 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1118
Practice Address - Country:US
Practice Address - Phone:702-259-7002
Practice Address - Fax:702-259-7003
Is Sole Proprietor?:No
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4100345428OtherDRIVER LICENSE