Provider Demographics
NPI:1649533902
Name:CARDENAS, KRISTINE ROSE IGNACIO (RPH)
Entity type:Individual
Prefix:
First Name:KRISTINE ROSE
Middle Name:IGNACIO
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:ROSE
Other - Last Name:IGNACIO-CARDENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:370 SW SEDGWICK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6432
Mailing Address - Country:US
Mailing Address - Phone:360-876-2698
Mailing Address - Fax:
Practice Address - Street 1:370 SW SEDGWICK RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6432
Practice Address - Country:US
Practice Address - Phone:360-876-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60036838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist