Healthcare Provider Details

I. General information

NPI: 1689127359
Provider Name (Legal Business Name): CHRISTINA HENKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41093 COUNTY CENTER DR
TEMECULA CA
92591-6025
US

IV. Provider business mailing address

29605 SOLANA WAY APT T08
TEMECULA CA
92591-5715
US

V. Phone/Fax

Practice location:
  • Phone: 800-323-6832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73442
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: