Provider Demographics
NPI:1679608665
Name:PIERONI, CHRISTOPHER B (R PH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:PIERONI
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 HIGHWAY 144 N
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-9511
Mailing Address - Country:US
Mailing Address - Phone:870-265-2799
Mailing Address - Fax:
Practice Address - Street 1:202 E STARLING ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4707
Practice Address - Country:US
Practice Address - Phone:662-335-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE08685OtherPHARMACY LICENSE