Provider Demographics
NPI:1043796808
Name:SMITH, CHRISTINA JEANETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JEANETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JEANETTE
Other - Last Name:WILKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:739 GODDARD AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005
Mailing Address - Country:US
Mailing Address - Phone:636-534-6800
Mailing Address - Fax:636-534-6797
Practice Address - Street 1:739 GODDARD AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005
Practice Address - Country:US
Practice Address - Phone:636-534-6800
Practice Address - Fax:636-534-6797
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298059183500000X
MO2014029962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist