Provider Demographics
NPI:1922354208
Name:WINTERS, KRISTEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:WINTERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:CARRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 RENAISSANCE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3086
Mailing Address - Country:US
Mailing Address - Phone:405-844-4978
Mailing Address - Fax:405-844-9473
Practice Address - Street 1:1701 RENAISSANCE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3086
Practice Address - Country:US
Practice Address - Phone:405-844-4978
Practice Address - Fax:405-844-9473
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK15230OtherPHARMD. LICENSE REGISTRATION #