Provider Demographics
NPI:1649043647
Name:VALDOVINOS, KRYSTA SHELBY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KRYSTA
Middle Name:SHELBY
Last Name:VALDOVINOS
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 1:6 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9622
Mailing Address - Country:US
Mailing Address - Phone:863-659-4744
Mailing Address - Fax:888-741-7969
Practice Address - Street 1:6 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9622
Practice Address - Country:US
Practice Address - Phone:863-659-4744
Practice Address - Fax:888-741-7969
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist