Provider Demographics
NPI:1700938834
Name:PEZZINO, KRISTY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:PEZZINO
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 1:49 ZEYA DRICE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238
Mailing Address - Country:US
Mailing Address - Phone:860-498-0063
Mailing Address - Fax:
Practice Address - Street 1:1103 BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-8110
Practice Address - Country:US
Practice Address - Phone:217-352-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS358551835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy