Provider Demographics
NPI:1801081773
Name:DRISCOLL, KRISTA K
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:K
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:K
Other - Last Name:SHAHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 405 BOX 0900
Mailing Address - Street 2:UNIT # 24021
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09110
Mailing Address - Country:US
Mailing Address - Phone:0114961-336-9759
Mailing Address - Fax:
Practice Address - Street 1:CMR 405 BOX 0900
Practice Address - Street 2:UNIT # 24021
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09110
Practice Address - Country:US
Practice Address - Phone:0114961-336-9759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14656183500000X
AZ10846183500000X
TX44635183500000X
IA20513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist