Provider Demographics
NPI:1093250193
Name:RIDLEY, CHRISTINE (CPHT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 38TH ST N
Mailing Address - Street 2:STE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2953
Mailing Address - Country:US
Mailing Address - Phone:701-893-9050
Mailing Address - Fax:701-893-9053
Practice Address - Street 1:706 38TH ST N
Practice Address - Street 2:STE A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2953
Practice Address - Country:US
Practice Address - Phone:701-893-9050
Practice Address - Fax:701-893-9053
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1095183700000X
MN727400183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician