Provider Demographics
NPI:1457869448
Name:PROCTOR, CHRISTINA ANN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ANN
Last Name:PROCTOR
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 1:4684 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3503
Mailing Address - Country:US
Mailing Address - Phone:850-526-3784
Mailing Address - Fax:
Practice Address - Street 1:4684 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3503
Practice Address - Country:US
Practice Address - Phone:850-526-3784
Practice Address - Fax:850-526-3784
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21558183500000X
FLPS61359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist