Provider Demographics
NPI:1346290186
Name:CHRISTIANI, MATTHEW EDEN (PTIC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EDEN
Last Name:CHRISTIANI
Suffix:
Gender:M
Credentials:PTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3056 LEIGHTON ST
Mailing Address - Street 2:B
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1533
Mailing Address - Country:US
Mailing Address - Phone:907-243-0622
Mailing Address - Fax:
Practice Address - Street 1:3056 LEIGHTON ST
Practice Address - Street 2:B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-1533
Practice Address - Country:US
Practice Address - Phone:907-243-0622
Practice Address - Fax:907-257-4687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK859183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician