Provider Demographics
NPI:1790337103
Name:CHRISTENSEN, BARRY DELANO (RPH)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:DELANO
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 TONGASS AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5635
Mailing Address - Country:US
Mailing Address - Phone:907-225-6186
Mailing Address - Fax:907-225-6187
Practice Address - Street 1:3526 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5635
Practice Address - Country:US
Practice Address - Phone:907-225-6186
Practice Address - Fax:907-225-6187
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist