Provider Demographics
NPI:1699143032
Name:LOVAS, KRISTEN BROOKE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BROOKE
Last Name:LOVAS
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 1:2508 E FOX FARM RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2559
Mailing Address - Country:US
Mailing Address - Phone:307-635-3618
Mailing Address - Fax:
Practice Address - Street 1:2508 E FOX FARM RD STE 1B
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2559
Practice Address - Country:US
Practice Address - Phone:307-635-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist