Provider Demographics
NPI:1316594898
Name:KATCHE, CHRIST ANGE G
Entity Type:Individual
Prefix:
First Name:CHRIST ANGE
Middle Name:G
Last Name:KATCHE
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 1:21 COLLEGE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4571
Mailing Address - Country:US
Mailing Address - Phone:716-931-1366
Mailing Address - Fax:
Practice Address - Street 1:21 COLLEGE AVE APT 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4571
Practice Address - Country:US
Practice Address - Phone:716-931-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist