=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629502778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER MARIAN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2017
-----------------------------------------------------
Last Update Date | 04/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1951 N HONORE AVE
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34235-9117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-684-3671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6000 2ND ST E UNIT #18
-----------------------------------------------------
City | ST PETE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33706-3753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-719-1789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS52267
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------