Provider Demographics
NPI:1861807893
Name:SORENSEN, CHRISTINA DIXON (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIXON
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SCALES RD
Mailing Address - Street 2:4203
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1822
Mailing Address - Country:US
Mailing Address - Phone:256-508-7575
Mailing Address - Fax:
Practice Address - Street 1:7780 MCGINNIS FERRY RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1622
Practice Address - Country:US
Practice Address - Phone:205-980-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL17728OtherSTATE LICENSE
GARPH029474OtherSTATE LICENSE