Provider Demographics
NPI:1063706018
Name:DANG, KRISTY (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:DANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FORTUNE DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2946
Mailing Address - Country:US
Mailing Address - Phone:949-885-0115
Mailing Address - Fax:949-885-0115
Practice Address - Street 1:115 FORTUNE DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2946
Practice Address - Country:US
Practice Address - Phone:949-885-0115
Practice Address - Fax:949-885-0115
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist