Provider Demographics
NPI:1528478187
Name:KRUSE, KINDRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KINDRA
Middle Name:
Last Name:KRUSE
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 1:1755 59TH PL
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7737
Mailing Address - Country:US
Mailing Address - Phone:515-358-8120
Mailing Address - Fax:515-358-8990
Practice Address - Street 1:1755 59TH PL
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7737
Practice Address - Country:US
Practice Address - Phone:515-358-8120
Practice Address - Fax:515-358-8990
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA182251835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA407690OtherNABP NUMBER
IA18225OtherPHARMACY LICENSE