Provider Demographics
NPI:1891089918
Name:DYM, KRISTINA S (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:S
Last Name:DYM
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 1:150 W 100TH AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2673
Mailing Address - Country:US
Mailing Address - Phone:907-267-7501
Mailing Address - Fax:907-267-7501
Practice Address - Street 1:150 W 100TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2673
Practice Address - Country:US
Practice Address - Phone:907-267-7501
Practice Address - Fax:907-267-7501
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist