Provider Demographics
NPI:1205136538
Name:DAILEY, KRISTIN CHERISE MARIKO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:CHERISE MARIKO
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:CHERISE MARIKO
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1750 WILLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9152
Mailing Address - Country:US
Mailing Address - Phone:541-744-1641
Mailing Address - Fax:541-744-1052
Practice Address - Street 1:29834 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5836
Practice Address - Country:US
Practice Address - Phone:480-563-9395
Practice Address - Fax:480-563-9331
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist