Provider Demographics
NPI:1245855220
Name:FROMMELT, KRISTINE M
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:FROMMELT
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 1:25982 TOM LUCAS RD
Mailing Address - Street 2:
Mailing Address - City:HOLY CROSS
Mailing Address - State:IA
Mailing Address - Zip Code:52053-9310
Mailing Address - Country:US
Mailing Address - Phone:563-581-0357
Mailing Address - Fax:
Practice Address - Street 1:4400 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-0406
Practice Address - Country:US
Practice Address - Phone:563-587-0586
Practice Address - Fax:563-587-0588
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist