Healthcare Provider Details

I. General information

NPI: 1154586469
Provider Name (Legal Business Name): CHRISTINA TOLIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W LEHIGH AVE
PHILADELPHIA PA
19133-3425
US

IV. Provider business mailing address

8820 RISING SUN AVE
PHILADELPHIA PA
19115-4815
US

V. Phone/Fax

Practice location:
  • Phone: 215-425-3784
  • Fax: 215-425-0740
Mailing address:
  • Phone: 215-934-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP441992
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: