Healthcare Provider Details

I. General information

NPI: 1851911283
Provider Name (Legal Business Name): CHRISTOPHER TILLER CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N GENESEE AVE
LOS ANGELES CA
90036-1841
US

IV. Provider business mailing address

508 N GENESEE AVE
LOS ANGELES CA
90036-1841
US

V. Phone/Fax

Practice location:
  • Phone: 323-918-6158
  • Fax:
Mailing address:
  • Phone: 323-918-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230027463
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: