Provider Demographics
NPI:1043534498
Name:BOUCHARD, CHRISTINE MARION (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARION
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FENNELL ST
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-1122
Mailing Address - Country:US
Mailing Address - Phone:315-685-0736
Mailing Address - Fax:
Practice Address - Street 1:40 FENNELL ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-1122
Practice Address - Country:US
Practice Address - Phone:315-685-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2014-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053693-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist