Provider Demographics
NPI:1821572918
Name:INTRAVAIA, CHRISTINA (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:INTRAVAIA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 W FINGERBOARD RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2632
Mailing Address - Country:US
Mailing Address - Phone:718-501-1455
Mailing Address - Fax:
Practice Address - Street 1:320 SMITH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4608
Practice Address - Country:US
Practice Address - Phone:718-403-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY064699OtherREGISTERED PHARMACIST