Provider Demographics
NPI:1619578754
Name:KONDRICK, CHRISTOPHER RAYMOND (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RAYMOND
Last Name:KONDRICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N GALILEO DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7893
Mailing Address - Country:US
Mailing Address - Phone:314-952-6160
Mailing Address - Fax:
Practice Address - Street 1:1102 N MASSEY BLVD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7607
Practice Address - Country:US
Practice Address - Phone:417-724-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016026652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist