Provider Demographics
NPI:1154762573
Name:EMMONS, CHRISTINE MARY
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
Last Name:EMMONS
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 1:295 51ST STREET GULF
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2611
Mailing Address - Country:US
Mailing Address - Phone:305-942-9555
Mailing Address - Fax:
Practice Address - Street 1:295 51ST STREET GULF
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2611
Practice Address - Country:US
Practice Address - Phone:305-942-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS26864OtherPHARMACY LICENSE
MI5302022865OtherPHARMACY LICENSE