Provider Demographics
NPI:1932883212
Name:WATERS, KRISTEN (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WATERS
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 1:9956 FANNY BROWN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9016
Mailing Address - Country:US
Mailing Address - Phone:585-633-0471
Mailing Address - Fax:
Practice Address - Street 1:9956 FANNY BROWN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-9016
Practice Address - Country:US
Practice Address - Phone:585-633-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070369183500000X
NC33660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist