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1629887120 NPI number — CHRISTINA DEREDZA-MASUKU

NPI Number: 1629887120
Health Care Provider/Practitioner: CHRISTINA DEREDZA-MASUKU

Information about “1629887120” NPI (CHRISTINA DEREDZA-MASUKU) exists in 1629887120 in HTML format HTML  |  1629887120 in plain Text format TXT  |  1629887120 in PDF (Portable Document Format) PDF  |  1629887120 in an XML format XML  formats.

NPI Number : 1629887120 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629887120",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEREDZA-MASUKU",
    "FirstName": "CHRISTINA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "512 SPRING MANOR BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GILBERTSVILLE",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19525-8002",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "215-237-7015",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "130 SCHUYLKILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHOENIXVILLE",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19460-2232",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "610-933-7487",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/31/2024",
    "LastUpdateDate": "12/31/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "RP459111",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "RP459111",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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