Provider Demographics
NPI:1932493285
Name:ELLISON, KRISTEN NICHOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICHOLE
Last Name:ELLISON
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 1:4301 MARICITE ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2159
Mailing Address - Country:US
Mailing Address - Phone:406-239-4314
Mailing Address - Fax:
Practice Address - Street 1:2925 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2566
Practice Address - Country:US
Practice Address - Phone:360-570-4617
Practice Address - Fax:360-570-4627
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60096405183500000X
MTPH60096405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist