Provider Demographics
NPI:1205107174
Name:JOSE, CHRISTNA T (RPH)
Entity type:Individual
Prefix:MISS
First Name:CHRISTNA
Middle Name:T
Last Name:JOSE
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 1:66 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1031
Mailing Address - Country:US
Mailing Address - Phone:516-869-0678
Mailing Address - Fax:
Practice Address - Street 1:66 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1031
Practice Address - Country:US
Practice Address - Phone:516-869-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056499-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist