Provider Demographics
NPI:1013365592
Name:WASKO, CHRISTINE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:WASKO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ALTA VISTA TER
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3201
Mailing Address - Country:US
Mailing Address - Phone:570-540-6541
Mailing Address - Fax:
Practice Address - Street 1:111 HULST DRIVE
Practice Address - Street 2:STE 722
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336
Practice Address - Country:US
Practice Address - Phone:570-491-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030754L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist