Provider Demographics
NPI:1730939406
Name:D'AMBROSIO, CHRISTIAN STEPHEN (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:STEPHEN
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 UXBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4587
Mailing Address - Country:US
Mailing Address - Phone:585-474-5318
Mailing Address - Fax:
Practice Address - Street 1:2301 E MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6245
Practice Address - Country:US
Practice Address - Phone:765-454-7810
Practice Address - Fax:765-454-7865
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030606A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist