Provider Demographics
NPI:1679907448
Name:NAGEL, KRISTIE MARIE
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:NAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:MARIE
Other - Last Name:STOREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2494 TUSCARORA CT
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8087
Mailing Address - Country:US
Mailing Address - Phone:321-750-3437
Mailing Address - Fax:
Practice Address - Street 1:250 CROCKETT BLVD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4395
Practice Address - Country:US
Practice Address - Phone:321-452-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist