Healthcare Provider Details

I. General information

NPI: 1992334940
Provider Name (Legal Business Name): KRISTINE MEILON MARKHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

1365 E VIA VIOLA WAY
FRESNO CA
93730-7065
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-9007
  • Fax:
Mailing address:
  • Phone: 916-207-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number75631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: