Provider Demographics
NPI:1750992947
Name:ROEDER, CHRISTINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:ROEDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 US HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-5609
Mailing Address - Country:US
Mailing Address - Phone:251-865-1429
Mailing Address - Fax:
Practice Address - Street 1:12550 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-5609
Practice Address - Country:US
Practice Address - Phone:251-865-1429
Practice Address - Fax:251-865-1478
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist