Provider Demographics
NPI:1942743315
Name:CHRISTY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 LINDY RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN VALLEYS
Mailing Address - State:PA
Mailing Address - Zip Code:17360-9226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 LINDY RD
Practice Address - Street 2:
Practice Address - City:SEVEN VALLEYS
Practice Address - State:PA
Practice Address - Zip Code:17360-9226
Practice Address - Country:US
Practice Address - Phone:717-747-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12086183500000X
PARP442457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist