Provider Demographics
NPI:1285245050
Name:CRUZ, KRISTEN ANGELA GARCIA (RPH)
Entity type:Individual
Prefix:
First Name:KRISTEN ANGELA
Middle Name:GARCIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8964 CYPRESS VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6311
Mailing Address - Country:US
Mailing Address - Phone:916-897-0543
Mailing Address - Fax:
Practice Address - Street 1:5420 DEWEY DR
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3138
Practice Address - Country:US
Practice Address - Phone:916-864-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist