Provider Demographics
NPI:1568173508
Name:WALL, CHRISTOPHER JARED (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JARED
Last Name:WALL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16148 CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2604
Mailing Address - Country:US
Mailing Address - Phone:562-713-0574
Mailing Address - Fax:562-777-7156
Practice Address - Street 1:12675 LA MIRADA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2249
Practice Address - Country:US
Practice Address - Phone:562-777-8175
Practice Address - Fax:562-777-7156
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist