Healthcare Provider Details

I. General information

NPI: 1639477110
Provider Name (Legal Business Name): IVANA KRSTIC IVANA KRSTIC, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVANA KRSTIC WATSON IVANA KRSTIC WATSON

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 DIVISADERO ST
SAN FRANCISCO CA
94123-2501
US

IV. Provider business mailing address

3201 DIVISADERO ST
SAN FRANCISCO CA
94123-2501
US

V. Phone/Fax

Practice location:
  • Phone: 415-931-6417
  • Fax:
Mailing address:
  • Phone: 415-931-6417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: