Healthcare Provider Details

I. General information

NPI: 1467861989
Provider Name (Legal Business Name): KRISTINE DALLAS FAFINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 MCMECHEN ST
BALTIMORE MD
21217-4301
US

IV. Provider business mailing address

238 MCMECHEN ST
BALTIMORE MD
21217-4301
US

V. Phone/Fax

Practice location:
  • Phone: 410-523-4704
  • Fax:
Mailing address:
  • Phone: 410-523-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21945
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: