Provider Demographics
NPI:1104391572
Name:SQUILLANTE, CHRISTINA M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:SQUILLANTE
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 1:1815 WADING RIVER MANOR RD
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2193
Mailing Address - Country:US
Mailing Address - Phone:631-929-0280
Mailing Address - Fax:631-929-0286
Practice Address - Street 1:1815 WADING RIVER MANOR RD
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2193
Practice Address - Country:US
Practice Address - Phone:631-929-0280
Practice Address - Fax:631-929-0286
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-04561183500000X
VT033.0134154183500000X
NY066296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist