Provider Demographics
NPI:1679869606
Name:LOUW, CHRISTA JANITA (B PHARM)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:JANITA
Last Name:LOUW
Suffix:
Gender:F
Credentials:B PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-939-9854
Mailing Address - Fax:208-939-2721
Practice Address - Street 1:250 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5906
Practice Address - Country:US
Practice Address - Phone:208-939-9854
Practice Address - Fax:208-939-2721
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist