Provider Demographics
NPI:1932874666
Name:MCNUTT, KRISTA LAUREN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LAUREN
Last Name:MCNUTT
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 1:2169 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-3668
Mailing Address - Country:US
Mailing Address - Phone:205-362-1639
Mailing Address - Fax:
Practice Address - Street 1:35767 US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:AL
Practice Address - Zip Code:35953-3056
Practice Address - Country:US
Practice Address - Phone:205-594-7088
Practice Address - Fax:205-594-5771
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist