Provider Demographics
NPI:1548692288
Name:WHITTAKER, CHRISTINA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12387 YELLOW BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2025
Mailing Address - Country:US
Mailing Address - Phone:904-751-2744
Mailing Address - Fax:
Practice Address - Street 1:12387 YELLOW BLUFF RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2025
Practice Address - Country:US
Practice Address - Phone:904-751-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist