Healthcare Provider Details

I. General information

NPI: 1609152016
Provider Name (Legal Business Name): KATHLEEN MARIE RISTING PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 10/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MCHENRY AVE
MODESTO CA
95350-3245
US

IV. Provider business mailing address

2001 MCHENRY AVE
MODESTO CA
95350-3245
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-6288
  • Fax: 209-571-6294
Mailing address:
  • Phone: 209-571-6288
  • Fax: 209-571-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH40183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: