Provider Demographics
NPI:1609395011
Name:KIDD, CHRISTINE ANITA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANITA
Last Name:KIDD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4628 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9387
Mailing Address - Country:US
Mailing Address - Phone:317-459-6177
Mailing Address - Fax:
Practice Address - Street 1:6110 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3507
Practice Address - Country:US
Practice Address - Phone:317-558-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014773A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist