Provider Demographics
NPI:1548090525
Name:SANTOUSE, CHRISTALEE-GAYLE SHIAN
Entity type:Individual
Prefix:
First Name:CHRISTALEE-GAYLE
Middle Name:SHIAN
Last Name:SANTOUSE
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 1:115 SEYMOUR DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9309
Mailing Address - Country:US
Mailing Address - Phone:802-624-8011
Mailing Address - Fax:
Practice Address - Street 1:115 SEYMOUR DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9309
Practice Address - Country:US
Practice Address - Phone:802-624-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0135450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist