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General NPI Number Information
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NPI Number | 1306309489
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Entity Type | Individual
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Provider Name | CHRISTINE MITRY RPH
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Gender | Female
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Dates
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Enumeration Date | 04/07/2019
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Last Update Date | 04/07/2019
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Provider Practice Location Address
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Address Line | 6490 CLAYTON RD
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City | CLAYTON
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State | CA
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Zip | 94517-1153
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Country | US
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Telephone | 925-673-2803
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Fax | 925-673-5530
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Provider Business Mailing Address
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Address Line | 105 FRESCO CT
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City | BRENTWOOD
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State | CA
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Zip | 94513-4268
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Country | US
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Telephone | 925-690-7793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 074740
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License Number State | CA
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