Provider Demographics
NPI:1639354871
Name:MACH, CHRISTINA M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:M
Last Name:MACH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:MACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:34 BAYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2203
Mailing Address - Country:US
Mailing Address - Phone:516-365-4704
Mailing Address - Fax:
Practice Address - Street 1:198 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5512
Practice Address - Country:US
Practice Address - Phone:516-561-1400
Practice Address - Fax:516-561-1428
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00397035Medicaid