Provider Demographics
NPI:1992027361
Name:GUSTAVSON, CHRISTINA (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GUSTAVSON
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 1:8 WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1041
Mailing Address - Country:US
Mailing Address - Phone:914-526-8325
Mailing Address - Fax:
Practice Address - Street 1:2000 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4412
Practice Address - Country:US
Practice Address - Phone:914-245-0292
Practice Address - Fax:914-245-8499
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042393183500000X
MA22169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist