Active NPI
Kristina Louise Vondrak, PHARM D
- Pharmacist
- Sioux City, IA
National Provider Identifier
1174144067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20009
- Practice address
- 4029 Teton Trce
Sioux City, IA 51104-4329 - Phone
- (712) 223-0463
- NPI assigned
- May 1, 2020
- Last updated
- May 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20009 | IA | Primary |
Addresses
Primary practice location
4029 Teton Trce
Sioux City, IA 51104-4329
Mailing address
4029 Teton Trce
Sioux City, IA 51104-4329
Phone (712) 223-0463
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20009 | Other | IA | PHARMACIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20009 | IA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588291200000",
"number": "1174144067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4029 TETON TRCE",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "511044329",
"telephone_number": "712-223-0463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4029 TETON TRCE",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "511044329",
"telephone_number": "712-223-0463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VONDRAK",
"first_name": "KRISTINA",
"middle_name": "LOUISE",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-01",
"last_updated": "2020-05-01",
"certification_date": "2020-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "20009",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "20009",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sioux City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.