Provider Demographics
NPI:1043878515
Name:WRZESIEN, CHRISTINA (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WRZESIEN
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 1:12 HEMPSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-7712
Mailing Address - Country:US
Mailing Address - Phone:410-491-4884
Mailing Address - Fax:
Practice Address - Street 1:1251 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6240
Practice Address - Country:US
Practice Address - Phone:302-998-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003676183500000X
MD17409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist