Provider Demographics
NPI:1093383861
Name:DEFOY, CHRISTOPHER WILLIS
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILLIS
Last Name:DEFOY
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 1:725 E VILLA MARIA RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5320
Mailing Address - Country:US
Mailing Address - Phone:979-822-1850
Mailing Address - Fax:
Practice Address - Street 1:725 E VILLA MARIA RD STE 1300
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5320
Practice Address - Country:US
Practice Address - Phone:979-822-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298629183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician