Provider Demographics
NPI:1154926830
Name:MARX, KRISTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MARX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:CERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:751 NE WOODS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:751 NE WOODS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1993
Practice Address - Country:US
Practice Address - Phone:816-524-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016028555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist