Provider Demographics
NPI:1154950764
Name:HART, CHRISTINA DIANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:DIANE
Last Name:HART
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 1:200 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1858
Mailing Address - Country:US
Mailing Address - Phone:573-243-1303
Mailing Address - Fax:573-243-1254
Practice Address - Street 1:200 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1858
Practice Address - Country:US
Practice Address - Phone:573-243-1303
Practice Address - Fax:573-243-1254
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist