Provider Demographics
NPI:1093147001
Name:DENNIS, MARIA CHRISTINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CHRISTINA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:420 W MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-5522
Mailing Address - Country:US
Mailing Address - Phone:574-259-7066
Mailing Address - Fax:574-259-2944
Practice Address - Street 1:906 S MERRIFIELD AVE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2807
Practice Address - Country:US
Practice Address - Phone:574-256-7522
Practice Address - Fax:574-256-7524
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018011A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1487685541OtherSTORE NPI