Healthcare Provider Details

I. General information

NPI: 1093250193
Provider Name (Legal Business Name): CHRISTINE RIDLEY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 38TH ST N STE A
FARGO ND
58102-2953
US

IV. Provider business mailing address

706 38TH ST N STE A
FARGO ND
58102-2953
US

V. Phone/Fax

Practice location:
  • Phone: 701-893-9050
  • Fax: 701-893-9053
Mailing address:
  • Phone: 701-893-9050
  • Fax: 701-893-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1095
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number727400
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: