Provider Demographics
NPI:1093099608
Name:CHRISTY, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26012 CAROLINES AVE, ANDERSEN AFB
Mailing Address - Street 2:
Mailing Address - City:YIGO
Mailing Address - State:GU
Mailing Address - Zip Code:96929
Mailing Address - Country:US
Mailing Address - Phone:671-366-5271
Mailing Address - Fax:
Practice Address - Street 1:26012 CAROLINES AVE, ANDERSEN AFB
Practice Address - Street 2:
Practice Address - City:YIGO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-366-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist