Provider Demographics
NPI:1962646737
Name:GORSKI, KRISTEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GORSKI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12188 COLFAX HWY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 E MAIN ST STE 13
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5854
Practice Address - Country:US
Practice Address - Phone:530-274-0100
Practice Address - Fax:702-384-3796
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67057183500000X
NV16985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist