Provider Demographics
NPI:1154553915
Name:THANAWIWAT, CHRISTINA SOPHIA (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SOPHIA
Last Name:THANAWIWAT
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 1:901 NEVIN AVE
Mailing Address - Street 2:BUILDING A, 2ND FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3143
Mailing Address - Country:US
Mailing Address - Phone:510-307-3173
Mailing Address - Fax:510-307-3174
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:BUILDING A, 2ND FLOOR
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-3173
Practice Address - Fax:510-307-3174
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist