Provider Demographics
NPI:1871112763
Name:KALTENBACH, TRISTA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRISTA
Middle Name:
Last Name:KALTENBACH
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 1:506 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1406
Mailing Address - Country:US
Mailing Address - Phone:605-205-0603
Mailing Address - Fax:
Practice Address - Street 1:4001 N 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1839
Practice Address - Country:US
Practice Address - Phone:605-205-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6730183500000X
IA23792183500000X
NE16584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist