Provider Demographics
NPI:1538232707
Name:LOES, KRISTOPHER A (RPH)
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:A
Last Name:LOES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8944 SHETLAND LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1070
Mailing Address - Country:US
Mailing Address - Phone:317-696-3072
Mailing Address - Fax:317-355-3115
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-355-3030
Practice Address - Fax:317-355-3115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017859A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy