Healthcare Provider Details

I. General information

NPI: 1043965767
Provider Name (Legal Business Name): CHRISTOPHER HUTSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CORAL RIDGE AVE
CORALVILLE IA
52241-2801
US

IV. Provider business mailing address

1441 CORAL RIDGE AVE
CORALVILLE IA
52241-2801
US

V. Phone/Fax

Practice location:
  • Phone: 319-248-1080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24111
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: