Provider Demographics
NPI:1346766409
Name:MARSH, CHRISTINE HANSMAN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:HANSMAN
Last Name:MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:CHRISTINE
Other - Last Name:HANSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3429
Mailing Address - Country:US
Mailing Address - Phone:413-537-2878
Mailing Address - Fax:
Practice Address - Street 1:20 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5805
Practice Address - Country:US
Practice Address - Phone:928-282-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0009341183500000X
CA31333183500000X
MAPH19466183500000X
NV06971183500000X
AZS015966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS015966OtherBOARD OF PHARMACY
CTPCT.0009341OtherBOARD OF PHARMACY
MAPH19466OtherBOARD OF PHARMACY
NV06971OtherBOARD OF PHARMACY
CA31333OtherBOARD OF PHARMACY