Provider Demographics
NPI:1922382787
Name:HALE, KRISTI L (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:HALE
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 1:3020 HAMMONS FORK RD
Mailing Address - Street 2:
Mailing Address - City:WOOLLUM
Mailing Address - State:KY
Mailing Address - Zip Code:40906-8730
Mailing Address - Country:US
Mailing Address - Phone:606-546-3020
Mailing Address - Fax:
Practice Address - Street 1:1121 S US HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-8005
Practice Address - Country:US
Practice Address - Phone:606-545-7314
Practice Address - Fax:606-545-5417
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014449183500000X
IN26020154A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26020154AOtherINDIANA PHARMACIST LICENSE
KY014449OtherKENTUCKY BOARD OF PHARMACY LICENSE NUMBER