Provider Demographics
NPI:1255763082
Name:ANDERSON, CHRISTINA LEE EIDEM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LEE EIDEM
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4423
Mailing Address - Country:US
Mailing Address - Phone:406-540-5130
Mailing Address - Fax:
Practice Address - Street 1:219 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4423
Practice Address - Country:US
Practice Address - Phone:406-540-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60362034183500000X
MTPHA-PHA-LIC-18611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist