Healthcare Provider Details

I. General information

NPI: 1316121668
Provider Name (Legal Business Name): CHRISTINE ANN MCENROE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CHEMUNG ST
HORSEHEADS NY
14845-2711
US

IV. Provider business mailing address

11843 OVERLOOK DR
CORNING NY
14830-9771
US

V. Phone/Fax

Practice location:
  • Phone: 607-739-0301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: