Provider Demographics
NPI:1265712079
Name:PEYERL, KRISTY (RPH)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:PEYERL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:ELBOW LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56531-4611
Mailing Address - Country:US
Mailing Address - Phone:218-685-4471
Mailing Address - Fax:
Practice Address - Street 1:11 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:ELBOW LAKE
Practice Address - State:MN
Practice Address - Zip Code:56531-4611
Practice Address - Country:US
Practice Address - Phone:218-685-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist