Provider Demographics
NPI:1184328957
Name:CORRADO, CHRISTINE LYNN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:CORRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LYNN
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:485 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4629
Mailing Address - Country:US
Mailing Address - Phone:845-338-4155
Mailing Address - Fax:845-338-3365
Practice Address - Street 1:485 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4629
Practice Address - Country:US
Practice Address - Phone:845-338-4155
Practice Address - Fax:845-338-3365
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357327183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician