Provider Demographics
NPI:1801146113
Name:MCGAVERN, CHRISTINA M (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:M
Last Name:MCGAVERN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:MANGIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:885 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1310
Mailing Address - Country:US
Mailing Address - Phone:518-459-4550
Mailing Address - Fax:518-459-0079
Practice Address - Street 1:885 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1310
Practice Address - Country:US
Practice Address - Phone:518-459-4550
Practice Address - Fax:518-459-0079
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI055762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist