Provider Demographics
NPI:1992043798
Name:ANDERSON, CHRISTOPHER LEROY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEROY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-0268
Mailing Address - Country:US
Mailing Address - Phone:928-697-4167
Mailing Address - Fax:928-697-4168
Practice Address - Street 1:HIGHWAY 163
Practice Address - Street 2:KAYENTA SERVICE CENTER
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4167
Practice Address - Fax:928-697-4168
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6141433-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist