Provider Demographics
NPI:1609042407
Name:PROCACCIANTI, CHRISTINA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:PROCACCIANTI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:PASSALACQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:245 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3557
Practice Address - Country:US
Practice Address - Phone:401-307-2555
Practice Address - Fax:401-783-0045
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011261183500000X
RIRPH04801183500000X
MA27125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist