Provider Demographics
NPI:1689050338
Name:ANTLE, CHRYSTINE RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRYSTINE
Middle Name:RENEE
Last Name:ANTLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3300
Mailing Address - Country:US
Mailing Address - Phone:954-757-4432
Mailing Address - Fax:
Practice Address - Street 1:5950 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3300
Practice Address - Country:US
Practice Address - Phone:954-757-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 53615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist