Provider Demographics
NPI:1982045639
Name:MINNEHAN, CHRISTA E (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:E
Last Name:MINNEHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 GENESEE VALLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9434
Mailing Address - Country:US
Mailing Address - Phone:585-243-9020
Mailing Address - Fax:585-243-9516
Practice Address - Street 1:4287 GENESEE VALLEY PLZ
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9434
Practice Address - Country:US
Practice Address - Phone:585-243-9020
Practice Address - Fax:585-243-9516
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist