Provider Demographics
NPI:1306077029
Name:DRISCOLL, KRISTEN MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIE
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:579 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2819
Mailing Address - Country:US
Mailing Address - Phone:518-782-1754
Mailing Address - Fax:
Practice Address - Street 1:579 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2819
Practice Address - Country:US
Practice Address - Phone:518-782-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033-0003832183500000X
NY053369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist