Provider Demographics
NPI:1487123410
Name:POWERS, KRISTINA (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:POWERS
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 1:58 PUBLIC SQ # 60
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-2610
Mailing Address - Country:US
Mailing Address - Phone:570-284-3757
Mailing Address - Fax:
Practice Address - Street 1:60 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-2610
Practice Address - Country:US
Practice Address - Phone:570-284-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist