Healthcare Provider Details

I. General information

NPI: 1194447771
Provider Name (Legal Business Name): KRISTEN CARTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W SIOUX AVE
PIERRE SD
57501-2425
US

IV. Provider business mailing address

120 W SIOUX AVE
PIERRE SD
57501-2425
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-7396
  • Fax:
Mailing address:
  • Phone: 605-224-7396
  • Fax: 605-224-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6106
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: