Provider Demographics
NPI:1699349654
Name:OUTLAW, CHRISTINA DANIELLE
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DANIELLE
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:DANIELLE
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9270 ALL SAINTS RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1702
Mailing Address - Country:US
Mailing Address - Phone:301-725-5008
Mailing Address - Fax:301-725-1517
Practice Address - Street 1:9270 ALL SAINTS RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1702
Practice Address - Country:US
Practice Address - Phone:301-725-5008
Practice Address - Fax:301-725-1517
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT15796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist