Provider Demographics
NPI:1972179851
Name:WAKELEY, KRISTINA (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:WAKELEY
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1071
Mailing Address - Country:US
Mailing Address - Phone:215-721-4300
Mailing Address - Fax:267-487-8977
Practice Address - Street 1:815 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1071
Practice Address - Country:US
Practice Address - Phone:215-721-4300
Practice Address - Fax:267-487-8977
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP440311OtherPHARMACIST LICENSE