Provider Demographics
NPI:1699104463
Name:KOMAIKO, KRISTEN ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ANN
Last Name:KOMAIKO
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 1:901 E CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-1308
Mailing Address - Country:US
Mailing Address - Phone:708-732-0297
Mailing Address - Fax:
Practice Address - Street 1:808 E WAKEFIELD AVE
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5147
Practice Address - Country:US
Practice Address - Phone:573-471-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130300431835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist