Provider Demographics
NPI:1699107110
Name:LUDOLPH, KRISTIN (PHARM D)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LUDOLPH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20311 GRANDE OAK SHOPPES BLVD
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-7662
Mailing Address - Country:US
Mailing Address - Phone:239-495-9013
Mailing Address - Fax:
Practice Address - Street 1:20311 GRANDE OAK SHOPPES BLVD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-7662
Practice Address - Country:US
Practice Address - Phone:239-495-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist