Provider Demographics
NPI:1922393180
Name:MONROE, KRISTA HICKS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:HICKS
Last Name:MONROE
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 1:1706 W INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2552
Mailing Address - Country:US
Mailing Address - Phone:704-636-1712
Mailing Address - Fax:704-637-0324
Practice Address - Street 1:1706 W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2552
Practice Address - Country:US
Practice Address - Phone:704-636-1712
Practice Address - Fax:704-637-0324
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12165OtherNC BOARD OF PHARMACY #