Provider Demographics
NPI:1346676111
Name:DAHL, CHRISTINE MARIE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DAHL
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 1:3450 N RIDGEWOOD ST.
Mailing Address - Street 2:APT. 721
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-4424
Mailing Address - Country:US
Mailing Address - Phone:402-540-1275
Mailing Address - Fax:
Practice Address - Street 1:3450 N RIDGEWOOD ST.
Practice Address - Street 2:APT. 721
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-4424
Practice Address - Country:US
Practice Address - Phone:402-540-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist