Provider Demographics
NPI:1700441268
Name:OBENRADER, KRISTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:OBENRADER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:MOTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1103 CARLL DR
Mailing Address - Street 2:
Mailing Address - City:TIONESTA
Mailing Address - State:PA
Mailing Address - Zip Code:16353-4407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11415 HYDETOWN RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1333
Practice Address - Country:US
Practice Address - Phone:814-827-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist