Provider Demographics
NPI:1821374331
Name:ETTER, CHRISTINE JILL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JILL
Last Name:ETTER
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 1:2635 RICE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3717
Mailing Address - Country:US
Mailing Address - Phone:651-483-3976
Mailing Address - Fax:651-483-0064
Practice Address - Street 1:2635 RICE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3717
Practice Address - Country:US
Practice Address - Phone:651-483-3976
Practice Address - Fax:651-483-0064
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist