Provider Demographics
NPI:1639117765
Name:BODEM, CHRISTINA (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:BODEM
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 1:121 DEPOT DR.
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387
Mailing Address - Country:US
Mailing Address - Phone:952-442-2146
Mailing Address - Fax:952-442-5643
Practice Address - Street 1:121 DEPOT DR.
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387
Practice Address - Country:US
Practice Address - Phone:952-442-2146
Practice Address - Fax:952-442-5643
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1162219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist