Provider Demographics
NPI:1730560921
Name:WILLIAMS-ELLIS, KRISTEN A (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:WILLIAMS-ELLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:3950 KEENE RD
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-4901
Practice Address - Country:US
Practice Address - Phone:509-942-3130
Practice Address - Fax:509-628-8335
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7057183500000X
WAPH60484940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist