Provider Demographics
NPI:1689858847
Name:WACHUKU, CHRISTINA TITILOLA (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:TITILOLA
Last Name:WACHUKU
Suffix:
Gender:F
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 1:950-960 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3402
Mailing Address - Country:US
Mailing Address - Phone:718-991-1376
Mailing Address - Fax:
Practice Address - Street 1:950-960 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3402
Practice Address - Country:US
Practice Address - Phone:718-991-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050010-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01592341Medicaid