Provider Demographics
NPI:1588964670
Name:NICITA, KRISTEN SUSANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:SUSANN
Last Name:NICITA
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 1:1 CAMINO ALTO
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2974
Mailing Address - Country:US
Mailing Address - Phone:415-388-2701
Mailing Address - Fax:415-388-7142
Practice Address - Street 1:1 CAMINO ALTO
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2974
Practice Address - Country:US
Practice Address - Phone:415-388-2701
Practice Address - Fax:415-388-7142
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist