Provider Demographics
NPI:1992003123
Name:CHRISTA, WALTER W (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:W
Last Name:CHRISTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-5611
Mailing Address - Country:US
Mailing Address - Phone:559-322-1003
Mailing Address - Fax:559-348-2273
Practice Address - Street 1:380 W ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-5611
Practice Address - Country:US
Practice Address - Phone:559-322-1003
Practice Address - Fax:559-348-2273
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432031835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist