Provider Demographics
NPI:1972804292
Name:CIRILLO, CHRISTIN BRENNAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:BRENNAN
Last Name:CIRILLO
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 1:103 W AMERICAN CANYON RD
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1112
Mailing Address - Country:US
Mailing Address - Phone:707-649-5160
Mailing Address - Fax:707-649-5166
Practice Address - Street 1:103 W AMERICAN CANYON RD
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1112
Practice Address - Country:US
Practice Address - Phone:707-649-5160
Practice Address - Fax:707-649-5166
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH51965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist