Healthcare Provider Details

I. General information

NPI: 1083647176
Provider Name (Legal Business Name): KRISTEN LOCKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST PHARMACY 119
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST PHARMACY 119
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-6322
  • Fax:
Mailing address:
  • Phone: 513-475-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number011828
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: