Provider Demographics
NPI:1598032161
Name:PETRYKIW, CHRISTINA ANNA (PHARMD, CDE)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ANNA
Last Name:PETRYKIW
Suffix:
Gender:F
Credentials:PHARMD, CDE
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:ANNA
Other - Last Name:KANAFOTSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, CDE
Mailing Address - Street 1:901 79TH ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4544
Mailing Address - Country:US
Mailing Address - Phone:630-963-9356
Mailing Address - Fax:
Practice Address - Street 1:901 79TH ST
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-4544
Practice Address - Country:US
Practice Address - Phone:630-963-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.038009183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist