Provider Demographics
NPI:1356348973
Name:GERICKE, KRISTIN R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:R
Last Name:GERICKE
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 1:1120 W LA VETA AVE
Mailing Address - Street 2:CALOPTIMA
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4231
Mailing Address - Country:US
Mailing Address - Phone:714-246-8460
Mailing Address - Fax:714-481-6411
Practice Address - Street 1:1120 W LA VETA AVE
Practice Address - Street 2:CALOPTIMA
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4231
Practice Address - Country:US
Practice Address - Phone:714-246-8460
Practice Address - Fax:714-481-6411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42772OtherLICENSE