Provider Demographics
NPI:1578046033
Name:CARRASCO, CHRISTINE PADILLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PADILLA
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 W YUCCA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3844
Mailing Address - Country:US
Mailing Address - Phone:408-914-8720
Mailing Address - Fax:
Practice Address - Street 1:4006 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2232
Practice Address - Country:US
Practice Address - Phone:602-971-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist