Provider Demographics
NPI:1619795879
Name:SHENODA, CHRISTINA (PHARMAD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SHENODA
Suffix:
Gender:F
Credentials:PHARMAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BARON LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5665
Mailing Address - Country:US
Mailing Address - Phone:551-241-9014
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS
Practice Address - Street 2:945 NJ- 34
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747
Practice Address - Country:US
Practice Address - Phone:732-583-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04389700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist