Provider Demographics
NPI:1114520004
Name:MAGNABOSCO, CHRISTINA ADRIANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ADRIANA
Last Name:MAGNABOSCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9617 KILDARE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1148
Mailing Address - Country:US
Mailing Address - Phone:773-569-9893
Mailing Address - Fax:
Practice Address - Street 1:101 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3801
Practice Address - Country:US
Practice Address - Phone:847-905-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051299642OtherIL LICENSE
IL051299642Medicaid