Provider Demographics
NPI:1801181953
Name:NELSON, CHRISTOPHER M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W MOUND RD
Mailing Address - Street 2:TARGET T-1951
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1965
Mailing Address - Country:US
Mailing Address - Phone:217-875-6550
Mailing Address - Fax:217-875-6550
Practice Address - Street 1:355 W MOUND RD
Practice Address - Street 2:TARGET T-1951
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1965
Practice Address - Country:US
Practice Address - Phone:217-875-6550
Practice Address - Fax:217-875-6550
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist