Provider Demographics
NPI:1053668632
Name:FRAZIER, CHRISTA NICOLE (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTA
Middle Name:NICOLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 GOLD STREAM DR
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-3031
Mailing Address - Country:US
Mailing Address - Phone:620-778-1531
Mailing Address - Fax:
Practice Address - Street 1:2001 S RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3240
Practice Address - Country:US
Practice Address - Phone:417-626-8553
Practice Address - Fax:417-626-8766
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011038927183500000X
KS1-15563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist