MEDICARE: MRS. CHRISTINA BLUE ASHWORTH RPH

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	051032191	IL

General Provider Information

NPI Number	:	1386926301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA BLUE ASHWORTH RPH

Provider Business Mailing Address
First Line	:	2513 S STONE CREEK BLVD
Second Line	:
City	:	URBANA
State	:	IL
Zip	:	61802-9436
Country	:	US
Telephone Number	:	217-259-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 PHILO RD
Second Line	:
City	:	URBANA
State	:	IL
Zip	:	61802-6015
Country	:	US
Telephone Number	:	217-367-5486
Fax Number	:	217-367-2437

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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