Provider Demographics
NPI:1871098475
Name:KOON, KRISTEN JO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:JO
Last Name:KOON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1106
Mailing Address - Country:US
Mailing Address - Phone:662-255-9131
Mailing Address - Fax:
Practice Address - Street 1:817 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3630
Practice Address - Country:US
Practice Address - Phone:662-620-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE12979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist