Provider Demographics
NPI:1720342561
Name:PETRIE, CHRISTINA LYNNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LYNNE
Last Name:PETRIE
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 1:10900 LAKELINE MALL DR
Mailing Address - Street 2:T-1797
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5924
Mailing Address - Country:US
Mailing Address - Phone:512-651-3377
Mailing Address - Fax:512-582-4948
Practice Address - Street 1:10900 LAKELINE MALL DR
Practice Address - Street 2:T-1797
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5924
Practice Address - Country:US
Practice Address - Phone:512-651-3377
Practice Address - Fax:512-582-4948
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist