Provider Demographics
NPI:1699060244
Name:OUELLETTE, CHRISTINA KENNEDY (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KENNEDY
Last Name:OUELLETTE
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 1:2530 WEIR RD
Mailing Address - Street 2:T-1017
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-5350
Mailing Address - Country:US
Mailing Address - Phone:804-768-9996
Mailing Address - Fax:804-768-9996
Practice Address - Street 1:2530 WEIR RD
Practice Address - Street 2:T-1017
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-5350
Practice Address - Country:US
Practice Address - Phone:804-768-9996
Practice Address - Fax:804-768-9996
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist