Provider Demographics
NPI:1962742502
Name:DRISCOLL, KRISTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DRISCOLL
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 1:46 TIEDEMANN CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4475
Mailing Address - Country:US
Mailing Address - Phone:860-839-0421
Mailing Address - Fax:
Practice Address - Street 1:59 N PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2126
Practice Address - Country:US
Practice Address - Phone:860-839-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist