Provider Demographics
NPI:1174296776
Name:CHRISTINE QUESENBERRY INCORPORATED
Entity Type:Organization
Organization Name:CHRISTINE QUESENBERRY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:831-423-7175
Mailing Address - Street 1:1401B MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4738
Mailing Address - Country:US
Mailing Address - Phone:831-423-7175
Mailing Address - Fax:
Practice Address - Street 1:1401B MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4738
Practice Address - Country:US
Practice Address - Phone:831-423-7175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy