Healthcare Provider Details

I. General information

NPI: 1447327853
Provider Name (Legal Business Name): CHRISTINA MARIA EVANGELISTA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST (MC 884) CSB SUITE 163
CHICAGO IL
60612
US

IV. Provider business mailing address

3454 N OLCOTT AVE
CHICAGO IL
60634-3341
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6783
  • Fax: 312-996-8525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51290699
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: