Provider Demographics
NPI:1528361722
Name:STEWART, CHRISTY ANNE (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ANNE
Last Name:STEWART
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 1:8 BUENA VISTA PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2502
Mailing Address - Country:US
Mailing Address - Phone:304-444-4223
Mailing Address - Fax:
Practice Address - Street 1:5 RIVER WALK MALL
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1026
Practice Address - Country:US
Practice Address - Phone:304-744-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist