Provider Demographics
NPI:1861776775
Name:KARDUM, KRISTOFER Z (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTOFER
Middle Name:Z
Last Name:KARDUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5534
Mailing Address - Country:US
Mailing Address - Phone:940-440-0400
Mailing Address - Fax:940-440-0401
Practice Address - Street 1:701 S HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-5534
Practice Address - Country:US
Practice Address - Phone:940-440-0400
Practice Address - Fax:940-440-0400
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243403336C0003X
TX44551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0376150002Medicare NSC