Provider Demographics
NPI:1104112960
Name:SACKS, KRISTINA B
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:B
Last Name:SACKS
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 1:15444 N. FRANK LLOYD WRIGHT BLVD.
Mailing Address - Street 2:TARGET PHARMACY 936
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-860-0219
Mailing Address - Fax:480-860-0219
Practice Address - Street 1:15444 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:TARGET PHARMACY 936
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2845
Practice Address - Country:US
Practice Address - Phone:480-860-0219
Practice Address - Fax:480-860-0219
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist