Provider Demographics
NPI:1538715453
Name:MOUNSEY, KRISTEN RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RENEE
Last Name:MOUNSEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-3904
Mailing Address - Country:US
Mailing Address - Phone:260-824-1646
Mailing Address - Fax:260-824-4795
Practice Address - Street 1:1203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-3904
Practice Address - Country:US
Practice Address - Phone:260-824-1646
Practice Address - Fax:260-824-4795
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028405A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist