Healthcare Provider Details

I. General information

NPI: 1184502528
Provider Name (Legal Business Name): CHRISTOPHER WADE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MARK WEST SPRINGS RD
SANTA ROSA CA
95403-1436
US

IV. Provider business mailing address

4798 HILLSBORO CIR
SANTA ROSA CA
95405-8786
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-4340
  • Fax:
Mailing address:
  • Phone: 707-536-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH54365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: