Provider Demographics
NPI:1548517873
Name:GREGORY, KRISTIN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:GREGORY
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 1:510 N ALLISON ST
Mailing Address - Street 2:APT A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-2704
Mailing Address - Country:US
Mailing Address - Phone:434-444-4867
Mailing Address - Fax:
Practice Address - Street 1:510 N ALLISON ST
Practice Address - Street 2:APT A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-2704
Practice Address - Country:US
Practice Address - Phone:434-444-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist