Provider Demographics
NPI:1396487823
Name:ROTH, KRISTY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:ROTH
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 1:211 W YOAKUM AVE
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740-1138
Mailing Address - Country:US
Mailing Address - Phone:573-887-3622
Mailing Address - Fax:573-887-3309
Practice Address - Street 1:211 W YOAKUM AVE
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:MO
Practice Address - Zip Code:63740-1138
Practice Address - Country:US
Practice Address - Phone:573-887-3622
Practice Address - Fax:573-887-3309
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019027652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist