Provider Demographics
NPI:1184168171
Name:VAUDO, CHRISTINE ELISE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELISE
Last Name:VAUDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SMITH ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2677
Mailing Address - Country:US
Mailing Address - Phone:978-729-7676
Mailing Address - Fax:
Practice Address - Street 1:41 BURLINGTON MALL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist