Provider Demographics
NPI:1669073565
Name:IGNACIO, KRISTEN PATRICIA (RPH)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:PATRICIA
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4909
Mailing Address - Country:US
Mailing Address - Phone:978-452-5255
Mailing Address - Fax:978-459-8433
Practice Address - Street 1:301 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4909
Practice Address - Country:US
Practice Address - Phone:978-452-5255
Practice Address - Fax:978-459-8433
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA23644OtherMA BOARD OF PHARMACY LICENSE NUMBER
NH3116OtherNH BOARD OF PHARMACY LICENSE NUMBER