Provider Demographics
NPI:1225743412
Name:MOLLER, CHRISTINA MARIE
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:MOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6406 MAUNA KEA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7146
Mailing Address - Country:US
Mailing Address - Phone:512-696-6565
Mailing Address - Fax:
Practice Address - Street 1:11810 RR 620 N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1347
Practice Address - Country:US
Practice Address - Phone:512-258-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX69189OtherLICENSE