Healthcare Provider Details

I. General information

NPI: 1457546202
Provider Name (Legal Business Name): CHRISTINE MARIE MADDOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE MARIE JOHNSTON PHARM.D.

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 MARTIN LUTHER KING JR WAY
BERKELEY CA
94704-1914
US

IV. Provider business mailing address

2424 MARTIN LUTHER KING JR WAY
BERKELEY CA
94704-1914
US

V. Phone/Fax

Practice location:
  • Phone: 559-349-1141
  • Fax:
Mailing address:
  • Phone: 559-349-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number59839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: