Provider Demographics
NPI:1750390555
Name:KROLL, KRISTIE L (RPH)
Entity type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:L
Last Name:KROLL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KRISTIE
Other - Middle Name:L
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3624 DORY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-423-0609
Mailing Address - Fax:
Practice Address - Street 1:9051 W HEATHER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224
Practice Address - Country:US
Practice Address - Phone:414-410-8261
Practice Address - Fax:414-410-3231
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12875040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist