MEDICARE: CHRISTINA GENDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS57034	FL

General Provider Information

NPI Number	:	1083123632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA GENDY

Provider Business Mailing Address
First Line	:	2428 MALABAR LAKES DR NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 PALM BAY RD STE 108
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32905-3863
Country	:	US
Telephone Number	:	321-499-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	09/27/2017

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Directions to “ CHRISTINA GENDY ” Practice Location

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