Healthcare Provider Details

I. General information

NPI: 1396751442
Provider Name (Legal Business Name): KRISTY M KLINGER PHARMD, PHC, BC-ADM,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/10/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 COLLEGE DRIVE
GALLUP NM
87301
US

IV. Provider business mailing address

2111 COLLEGE DRIVE
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-397-5772
  • Fax: 877-396-1184
Mailing address:
  • Phone: 505-397-5772
  • Fax: 877-396-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP044505L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15059
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000408
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP000009486
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: