Provider Demographics
NPI:1730402280
Name:CRANDALL, CHRISTINE EMILY (PHARM D)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EMILY
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:EMILY
Other - Last Name:RENZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6171 WOODFORD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9457
Mailing Address - Country:US
Mailing Address - Phone:716-462-4866
Mailing Address - Fax:
Practice Address - Street 1:219 BYRANT STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051162183500000X
FLPS44379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist