Provider Demographics
NPI:1932303971
Name:HAXMEIER, KRISTINA ANN IV (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:HAXMEIER
Suffix:IV
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 1:22907 300TH ST
Mailing Address - Street 2:
Mailing Address - City:LA MOTTE
Mailing Address - State:IA
Mailing Address - Zip Code:52054
Mailing Address - Country:US
Mailing Address - Phone:563-773-2755
Mailing Address - Fax:563-557-7453
Practice Address - Street 1:400 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7419
Practice Address - Country:US
Practice Address - Phone:563-582-1143
Practice Address - Fax:563-557-5453
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist