Provider Demographics
NPI:1851648505
Name:CHRISTA, GRETTA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GRETTA
Middle Name:
Last Name:CHRISTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 E NEES AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9051
Mailing Address - Country:US
Mailing Address - Phone:559-322-1003
Mailing Address - Fax:
Practice Address - Street 1:205 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3602
Practice Address - Country:US
Practice Address - Phone:559-325-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist