Provider Demographics
NPI:1013674787
Name:COUSINS, KRISTEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:COUSINS
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 1:2201 N BUFFALO DR APT 1088
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0278
Mailing Address - Country:US
Mailing Address - Phone:954-805-3378
Mailing Address - Fax:
Practice Address - Street 1:201 N NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5321
Practice Address - Country:US
Practice Address - Phone:702-452-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist