Healthcare Provider Details

I. General information

NPI: 1891241246
Provider Name (Legal Business Name): KRISTI VIOLET MRAZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 TAMIAMI TRL E
NAPLES FL
34112-6718
US

IV. Provider business mailing address

8141 SARATOGA DR UNIT 1903
NAPLES FL
34113-3023
US

V. Phone/Fax

Practice location:
  • Phone: 239-793-7821
  • Fax:
Mailing address:
  • Phone: 330-774-9076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS55545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: