MEDICARE: KRISTINE HA PHARM.D.

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	16490	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4100345428	OTHER	NV	DRIVER LICENSE

General Provider Information

NPI Number	:	1851678221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE HA PHARM.D.

Provider Business Mailing Address
First Line	:	6401 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1118
Country	:	US
Telephone Number	:	702-259-7002
Fax Number	:	702-259-7003

Provider Business Practice Location Address
First Line	:	6401 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1118
Country	:	US
Telephone Number	:	702-259-7002
Fax Number	:	702-259-7003

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

Provider Enumeration Date	:	11/12/2011
Last Update Date	:	11/12/2011

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