Provider Demographics
NPI:1184097867
Name:DIERICKXGOMEZ, CHRISTINE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:DIERICKXGOMEZ
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 1:1570 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3718
Mailing Address - Country:US
Mailing Address - Phone:310-536-9255
Mailing Address - Fax:310-643-0089
Practice Address - Street 1:1570 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3718
Practice Address - Country:US
Practice Address - Phone:310-536-9255
Practice Address - Fax:310-643-0089
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist