Provider Demographics
NPI:1922432491
Name:PRATT, KRISTIE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:PRATT
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 1:294 COVENTRY ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-1973
Mailing Address - Country:US
Mailing Address - Phone:315-409-8214
Mailing Address - Fax:
Practice Address - Street 1:59 WATERFRONT PLZ
Practice Address - Street 2:STE 2
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4877
Practice Address - Country:US
Practice Address - Phone:802-334-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0097774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist