Provider Demographics
NPI:1720510878
Name:LAFOLLETTE, KRISTIN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LAFOLLETTE
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 1:4781 BARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9329
Mailing Address - Country:US
Mailing Address - Phone:217-412-2994
Mailing Address - Fax:844-243-3856
Practice Address - Street 1:4781 BARBERRY CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9329
Practice Address - Country:US
Practice Address - Phone:217-412-2994
Practice Address - Fax:844-243-3856
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510398801835X0200X
IL051-039880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835X0200XPharmacy Service ProvidersPharmacistOncology