1962650127 NPI number — DR. KRISTEN RENEE HALFORD PHARM D

Table of content: DR. KRISTEN RENEE HALFORD PHARM D (NPI 1962650127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962650127 NPI number — DR. KRISTEN RENEE HALFORD PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALFORD
Provider First Name:
KRISTEN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962650127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 DAVIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW MADRID
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63869-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-748-5165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYTI
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63851-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-359-0008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  2007022182 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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