Provider Demographics
NPI:1396972014
Name:ROBATAILLE, CHRISTINE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:ROBATAILLE
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 1:233 5TH AVE EXT
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1814
Mailing Address - Country:US
Mailing Address - Phone:518-773-8577
Mailing Address - Fax:518-773-8577
Practice Address - Street 1:233 5TH AVE EXT
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1814
Practice Address - Country:US
Practice Address - Phone:518-773-8577
Practice Address - Fax:518-773-8577
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-20
Last Update Date:2009-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist