Basic Information
| Provider Information | |||||||||
| NPI: | 1679661268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PELLINGRA | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PHARM.D., BCPS, BCPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1876 E SABIN DR BLDG A | ||||||||
| Address2: | |||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851226197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207921450 | ||||||||
| FaxNumber: | 5203685794 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 S 6TH AVE # 13-119 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207921450 | ||||||||
| FaxNumber: | 5206291864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH 00065741 | WA | N | Pharmacy Service Providers | Pharmacist | 1835P1200X | PH 00065741 | WA | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1300X | PH 00065741 | WA | Y | Pharmacy Service Providers | Pharmacist | Psychiatric |
No ID Information.