Provider Demographics
NPI:1174144067
Name:VONDRAK, KRISTINA LOUISE (PHARM D)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LOUISE
Last Name:VONDRAK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 TETON TRCE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-4329
Mailing Address - Country:US
Mailing Address - Phone:712-223-0463
Mailing Address - Fax:
Practice Address - Street 1:4029 TETON TRCE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-4329
Practice Address - Country:US
Practice Address - Phone:712-223-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20009OtherPHARMACIST LICENSE