Provider Demographics
NPI:1447532171
Name:PIPER, KRISTIN KAYE
Entity type:Individual
Prefix:PROF
First Name:KRISTIN
Middle Name:KAYE
Last Name:PIPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15600 VFW RD
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-4168
Mailing Address - Country:US
Mailing Address - Phone:618-635-3313
Mailing Address - Fax:
Practice Address - Street 1:1122 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1848
Practice Address - Country:US
Practice Address - Phone:618-259-2013
Practice Address - Fax:618-259-2098
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist