Provider Demographics
NPI:1699060871
Name:BANGERT, CHRISTOPHER P (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:BANGERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 SR 26 EAST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4807
Mailing Address - Country:US
Mailing Address - Phone:765-447-4411
Mailing Address - Fax:765-447-4411
Practice Address - Street 1:3630 SR 26 EAST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4807
Practice Address - Country:US
Practice Address - Phone:765-447-4411
Practice Address - Fax:765-447-4411
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023104A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist