Provider Demographics
NPI:1366726937
Name:DEDMON, KRISTAIN BRADLEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTAIN
Middle Name:BRADLEY
Last Name:DEDMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2904
Mailing Address - Country:US
Mailing Address - Phone:870-394-3060
Mailing Address - Fax:888-804-2856
Practice Address - Street 1:430 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2904
Practice Address - Country:US
Practice Address - Phone:870-394-3060
Practice Address - Fax:888-804-2856
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33841183500000X
ARPD11142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist