Provider Demographics
NPI:1912220070
Name:MCILWRAITH, KRISTEN M (KRISTEN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:M
Last Name:MCILWRAITH
Suffix:
Gender:F
Credentials:KRISTEN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:STROHMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KRISTEN
Mailing Address - Street 1:3046 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9723
Mailing Address - Country:US
Mailing Address - Phone:856-727-1299
Mailing Address - Fax:
Practice Address - Street 1:3046 ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9723
Practice Address - Country:US
Practice Address - Phone:856-727-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051561-1183500000X
NJ28RI02628400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist