Provider Demographics
NPI:1124116645
Name:GOEHRING, KRISTIN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:GOEHRING
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:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-0136
Mailing Address - Country:US
Mailing Address - Phone:605-881-6841
Mailing Address - Fax:
Practice Address - Street 1:411 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226
Practice Address - Country:US
Practice Address - Phone:605-874-8220
Practice Address - Fax:605-874-8218
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist