Provider Demographics
NPI:1992422398
Name:BALDERSON, KRISTY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BALDERSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:KB
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8060 WISTAR GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3620
Mailing Address - Country:US
Mailing Address - Phone:804-398-9069
Mailing Address - Fax:
Practice Address - Street 1:9555 KINGS CHARTER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7994
Practice Address - Country:US
Practice Address - Phone:800-753-0596
Practice Address - Fax:804-799-7917
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist