Provider Demographics
NPI:1861017410
Name:PHANSANA, KRISTINE ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINE ANN
Middle Name:
Last Name:PHANSANA
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 1:2116 THOMPSON RD STE G1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5428
Mailing Address - Country:US
Mailing Address - Phone:832-418-1676
Mailing Address - Fax:
Practice Address - Street 1:2116 THOMPSON RD STE G1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5428
Practice Address - Country:US
Practice Address - Phone:832-418-1676
Practice Address - Fax:832-363-1612
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX489021835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist