Provider Demographics
NPI:1386926301
Name:ASHWORTH, CHRISTINA BLUE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:BLUE
Last Name:ASHWORTH
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 1:2513 S STONE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9436
Mailing Address - Country:US
Mailing Address - Phone:217-259-2816
Mailing Address - Fax:
Practice Address - Street 1:1801 PHILO RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-6015
Practice Address - Country:US
Practice Address - Phone:217-367-5486
Practice Address - Fax:217-367-2437
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist