Provider Demographics
NPI:1477142800
Name:LIZARRAGA, CHIRSTIN J
Entity Type:Individual
Prefix:
First Name:CHIRSTIN
Middle Name:J
Last Name:LIZARRAGA
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 1:2250 BOCA CHICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2216
Mailing Address - Country:US
Mailing Address - Phone:956-541-0384
Mailing Address - Fax:866-547-7941
Practice Address - Street 1:2250 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2216
Practice Address - Country:US
Practice Address - Phone:956-541-0384
Practice Address - Fax:866-547-7941
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168233183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician