Provider Demographics
NPI:1457911869
Name:SPOON, KRISTEN ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ANNE
Last Name:SPOON
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 1:841 OLD WINSTON RD STE 90
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7145
Mailing Address - Country:US
Mailing Address - Phone:336-497-4511
Mailing Address - Fax:
Practice Address - Street 1:841 OLD WINSTON RD STE 90
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7145
Practice Address - Country:US
Practice Address - Phone:336-497-4511
Practice Address - Fax:336-497-4511
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist