Provider Demographics
NPI:1295364701
Name:PHAN, CHRISTINA MARY (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARY
Last Name:PHAN
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 1:2220 BOW LN
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-2005
Mailing Address - Country:US
Mailing Address - Phone:727-692-1521
Mailing Address - Fax:813-963-6801
Practice Address - Street 1:6192 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4014
Practice Address - Country:US
Practice Address - Phone:727-692-1521
Practice Address - Fax:813-963-6801
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist