MEDICARE: CHRISTINA PAULINE NORDAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	16482	LA

General Provider Information

NPI Number	:	1639420219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA PAULINE NORDAN RPH

Provider Business Mailing Address
First Line	:	1720 W PRIEN LAKE RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8361
Country	:	US
Telephone Number	:	337-562-7802
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 W PRIEN LAKE RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8361
Country	:	US
Telephone Number	:	337-562-7802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	09/24/2012

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