Provider Demographics
NPI:1699117986
Name:CARBONE, CHRISTINA NICOLE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:CARBONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3510
Mailing Address - Country:US
Mailing Address - Phone:716-208-6620
Mailing Address - Fax:
Practice Address - Street 1:2561 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2205
Practice Address - Country:US
Practice Address - Phone:716-668-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 058138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist