Provider Demographics
NPI:1366518748
Name:KOBOLD, KRISTEN LYNN (RPH, PHARMD BCPS)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LYNN
Last Name:KOBOLD
Suffix:
Gender:F
Credentials:RPH, PHARMD BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 CHESTNUT RIVER XING
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8761
Mailing Address - Country:US
Mailing Address - Phone:317-272-0130
Mailing Address - Fax:
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:SUITE #211
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-355-6895
Practice Address - Fax:317-355-6916
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017298A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy