Provider Demographics
NPI:1285482976
Name:HILDEBRAND, KRISTEN (RPH, PHD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 VT 12 S
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-9237
Mailing Address - Country:US
Mailing Address - Phone:802-728-6284
Mailing Address - Fax:
Practice Address - Street 1:151 VT 12 S
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-9237
Practice Address - Country:US
Practice Address - Phone:802-728-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0135065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist