Provider Demographics
NPI:1972106797
Name:FORTON, KRISTINA N
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:N
Last Name:FORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 VALLEY PLAZA PKWY
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41017-8113
Mailing Address - Country:US
Mailing Address - Phone:859-341-3714
Mailing Address - Fax:859-341-3739
Practice Address - Street 1:3450 VALLEY PLAZA PKWY
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41017-8113
Practice Address - Country:US
Practice Address - Phone:859-341-3714
Practice Address - Fax:859-341-3739
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist