Provider Demographics
NPI:1467792689
Name:VILLANUEVA, CHRISTOPHER MAITH (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MAITH
Last Name:VILLANUEVA
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:PO BOX 28127
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-8127
Mailing Address - Country:US
Mailing Address - Phone:206-778-6851
Mailing Address - Fax:
Practice Address - Street 1:4130 38TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1318
Practice Address - Country:US
Practice Address - Phone:206-535-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00063526183500000X
OHRPH.03119032-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist