Provider Demographics
NPI:1033493952
Name:JENNINGS, CHRISTIAN PATERSON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:PATERSON
Last Name:JENNINGS
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 1:2326 ROBINHOOD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1028
Mailing Address - Country:US
Mailing Address - Phone:336-725-5675
Mailing Address - Fax:
Practice Address - Street 1:207 ASH ST STE A
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-6809
Practice Address - Country:US
Practice Address - Phone:336-677-5000
Practice Address - Fax:336-677-5010
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist