Provider Demographics
NPI:1205383171
Name:BOLES, CHRISTENA (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTENA
Middle Name:
Last Name:BOLES
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 1:23421 N 120TH DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-5072
Mailing Address - Country:US
Mailing Address - Phone:480-307-5325
Mailing Address - Fax:
Practice Address - Street 1:8375 W DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2460
Practice Address - Country:US
Practice Address - Phone:623-561-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist