Basic Information
| Provider Information | |||||||||
| NPI: | 1174589162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEISINGER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | REBEKAH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RENGEN | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | REBEKAH | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 S 99TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOLLESON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853539700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252992028 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2858 N PINAL AVE | ||||||||
| Address2: | |||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851227917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204264701 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH00063929 | WA | N | Pharmacy Service Providers | Pharmacist | 183500000X | S019797 | AZ | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | PH00063929 | 01 | WA | PHARMACIST | OTHER | PH60113517 | 01 | WA | WASHINGTON STATE BOARD OF PHARMACY | OTHER | S019797 | 01 | AZ | ARIZONA STATE BOARD OF PHARMACY | OTHER |