Provider Demographics
NPI:1104578525
Name:LEY, CHRISTINA JANEEN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JANEEN
Last Name:LEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 N BALLAS RD STE 100D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2330
Mailing Address - Country:US
Mailing Address - Phone:314-657-9008
Mailing Address - Fax:314-996-7502
Practice Address - Street 1:3023 N BALLAS RD STE 100D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2330
Practice Address - Country:US
Practice Address - Phone:314-657-9008
Practice Address - Fax:314-996-7502
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013037628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist