MEDICARE: DR. KRISTI ANN KUBOSH 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	48761	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48761	OTHER	TX	TEXAS PHARMACIST LICENSE

General Provider Information

NPI Number	:	1508403973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTI ANN KUBOSH PHARMD

Provider Business Mailing Address
First Line	:	4941 REIGER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-5422
Country	:	US
Telephone Number	:	979-218-4735
Fax Number	:

Provider Business Practice Location Address
First Line	:	4941 REIGER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-5422
Country	:	US
Telephone Number	:	979-218-4735
Fax Number	:

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

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/04/2019

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