Provider Demographics
NPI:1437321858
Name:PRENDERGAST, CHRISTOPHER THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:PRENDERGAST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 N WICKHAM RD
Mailing Address - Street 2:STE 109
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2485
Mailing Address - Country:US
Mailing Address - Phone:321-242-6166
Mailing Address - Fax:321-242-6701
Practice Address - Street 1:4100 N WICKHAM RD
Practice Address - Street 2:STE 109
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2485
Practice Address - Country:US
Practice Address - Phone:321-242-6166
Practice Address - Fax:321-242-6701
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 33794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist