Provider Demographics
NPI:1942581004
Name:MAES, KRISTEL LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:LYNN
Last Name:MAES
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 1:1329 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1116
Mailing Address - Country:US
Mailing Address - Phone:504-837-5899
Mailing Address - Fax:
Practice Address - Street 1:1435 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2738
Practice Address - Country:US
Practice Address - Phone:985-223-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist