Healthcare Provider Details

I. General information

NPI: 1457859365
Provider Name (Legal Business Name): KRISTINA HAZARD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TOWNPARK LN NW
KENNESAW GA
30144-5579
US

IV. Provider business mailing address

1922 ENCHANTED WOODS TRL
MARIETTA GA
30066-1979
US

V. Phone/Fax

Practice location:
  • Phone: 770-514-5483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH025940
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: