Healthcare Provider Details

I. General information

NPI: 1679661268
Provider Name (Legal Business Name): KRISTEN M PELLINGRA PHARM.D., BCPS, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE # 13-119
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

1876 E SABIN DR BLDG A
CASA GRANDE AZ
85122-6197
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-629-1864
Mailing address:
  • Phone: 520-792-1450
  • Fax: 520-368-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 00065741
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH 00065741
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH 00065741
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: