Provider Demographics
NPI:1124143672
Name:KIRK, CHRISTEN MARY (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:MARY
Last Name:KIRK
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 1:69 CHIPPEWA CT
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4722
Mailing Address - Country:US
Mailing Address - Phone:716-479-6439
Mailing Address - Fax:
Practice Address - Street 1:1275 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-2126
Practice Address - Country:US
Practice Address - Phone:716-816-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist