Provider Demographics
NPI:1740595859
Name:SIDRAK, CHRISTINA NEVERTE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NEVERTE
Last Name:SIDRAK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:SIDRAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2325 VINEYARD DR
Mailing Address - Street 2:UNIT C8
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8297
Mailing Address - Country:US
Mailing Address - Phone:843-267-8289
Mailing Address - Fax:
Practice Address - Street 1:4211 NC HIGHWAY 11 SOUTH
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590
Practice Address - Country:US
Practice Address - Phone:252-215-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20797183500000X
SC12734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist