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General NPI Number Information
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NPI Number | 1346831153
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Entity Type | Individual
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Provider Name | KRISTEN RENEE CARL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 3690 NW 53RD ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-2452
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Country | US
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Telephone | 866-209-2178
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Fax |
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Provider Business Mailing Address
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Address Line | 2573 GALIANO AVE SW
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City | PALM BAY
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State | FL
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Zip | 32908-1355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS39098
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License Number State | FL
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