Provider Demographics
NPI:1578876603
Name:ABERNATHY, KHRISTINE LOUISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KHRISTINE
Middle Name:LOUISE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 COUNTY ROAD 602
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7889
Mailing Address - Country:US
Mailing Address - Phone:573-335-9453
Mailing Address - Fax:
Practice Address - Street 1:824 COUNTY ROAD 602
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7889
Practice Address - Country:US
Practice Address - Phone:573-335-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist