Provider Demographics
NPI:1114027836
Name:ANDERSON, KRISTEN SUZANNE (RPH)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1 CRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8805
Mailing Address - Country:US
Mailing Address - Phone:970-769-5151
Mailing Address - Fax:
Practice Address - Street 1:RUSTLING WILLOW STREET
Practice Address - Street 2:COMPLEX D
Practice Address - City:TOWAOC
Practice Address - State:CO
Practice Address - Zip Code:81334
Practice Address - Country:US
Practice Address - Phone:970-565-4441
Practice Address - Fax:970-565-3578
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist