Provider Demographics
NPI:1528248929
Name:SELZER, KRISTINE DIANE (RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:DIANE
Last Name:SELZER
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 1:408 FIVE LEAF LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7047
Mailing Address - Country:US
Mailing Address - Phone:516-644-6433
Mailing Address - Fax:
Practice Address - Street 1:408 FIVE LEAF LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7047
Practice Address - Country:US
Practice Address - Phone:516-644-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist