Provider Demographics
NPI:1962014944
Name:CANIDA, CHRISTOPHER TATE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TATE
Last Name:CANIDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4415
Mailing Address - Country:US
Mailing Address - Phone:423-499-4262
Mailing Address - Fax:
Practice Address - Street 1:8714 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4415
Practice Address - Country:US
Practice Address - Phone:423-499-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT42855183500000X
TN42879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist