Healthcare Provider Details

I. General information

NPI: 1609973023
Provider Name (Legal Business Name): CHRISTOPHER M. HERNDON PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S 3RD ST SUITE 400
BELLEVILLE IL
62220-1952
US

IV. Provider business mailing address

180 S 3RD ST SUITE 400
BELLEVILLE IL
62220-1952
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7880
  • Fax: 618-222-4792
Mailing address:
  • Phone: 618-233-7880
  • Fax: 618-222-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: