Healthcare Provider Details

I. General information

NPI: 1396891313
Provider Name (Legal Business Name): JUDITH LYN KRISTELLER PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MEADOWCREST DR
SHAVERTOWN PA
18708-9707
US

IV. Provider business mailing address

1081 MEADOWCREST DR
SHAVERTOWN PA
18708-9707
US

V. Phone/Fax

Practice location:
  • Phone: 570-408-4272
  • Fax: 570-408-7729
Mailing address:
  • Phone: 570-408-4272
  • Fax: 570-408-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP438040
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: