Healthcare Provider Details

I. General information

NPI: 1689274367
Provider Name (Legal Business Name): KRISTEN BAALBAKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 POST RD
WARWICK RI
02888-6308
US

IV. Provider business mailing address

840 POST RD
WARWICK RI
02888-6308
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-8340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH05136
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: