Provider Demographics
NPI:1720361991
Name:BERRY, CHRISTY L (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:BERRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S UPPER BROADWAY
Mailing Address - Street 2:CLIFF HOUSE CONDOMINIUMS #805
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401
Mailing Address - Country:US
Mailing Address - Phone:270-790-1180
Mailing Address - Fax:361-961-2688
Practice Address - Street 1:NAVAL HEALTH CLINIC CORPUS CHRISTI
Practice Address - Street 2:10651 E STREET
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419
Practice Address - Country:US
Practice Address - Phone:361-961-6174
Practice Address - Fax:361-961-2688
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX529821835P0018X
KY010605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX52982OtherTEXAS BOARD OF PHARMACY