Provider Demographics
NPI:1336699198
Name:CHRISTISON, REMYA S
Entity Type:Individual
Prefix:
First Name:REMYA
Middle Name:S
Last Name:CHRISTISON
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 1:28C BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5429
Mailing Address - Country:US
Mailing Address - Phone:203-512-1557
Mailing Address - Fax:
Practice Address - Street 1:28C BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5429
Practice Address - Country:US
Practice Address - Phone:203-512-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist