Basic Information
| Provider Information | |||||||||
| NPI: | 1396802385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLLIVER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 N QUENTIN RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430554669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403442191 | ||||||||
| FaxNumber: | 7403446308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1649 GRANVILLE RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403442191 | ||||||||
| FaxNumber: | 7403446308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03-2-13940 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.