MEDICARE: KRISTEN PROCTOR PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03132159	OH
2	183500000X	Pharmacist	016149	KY

General Provider Information

NPI Number	:	1386036820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN PROCTOR PHARMD.

Provider Business Mailing Address
First Line	:	3609 WARSAW AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1721
Country	:	US
Telephone Number	:	513-598-7890
Fax Number	:

Provider Business Practice Location Address
First Line	:	3609 WARSAW AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1721
Country	:	US
Telephone Number	:	513-598-7890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	02/20/2015

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Directions to “ KRISTEN PROCTOR PHARMD.” Practice Location

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