Provider Demographics
NPI:1720388028
Name:CLOSE, CHRISTOPHER SHAWN (BSC PHARMACY RPH)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SHAWN
Last Name:CLOSE
Suffix:
Gender:M
Credentials:BSC PHARMACY RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4325
Mailing Address - Country:US
Mailing Address - Phone:509-522-4672
Mailing Address - Fax:509-525-8985
Practice Address - Street 1:1600 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4325
Practice Address - Country:US
Practice Address - Phone:509-522-4672
Practice Address - Fax:509-525-8985
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60123574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist