Provider Demographics
NPI:1063863249
Name:FOURNIER, DEENA RUSSELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEENA
Middle Name:RUSSELL
Last Name:FOURNIER
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 1:11980 HIGHWAY 17 BYP
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9339
Mailing Address - Country:US
Mailing Address - Phone:843-357-2000
Mailing Address - Fax:
Practice Address - Street 1:11980 HIGHWAY 17 BYP
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9339
Practice Address - Country:US
Practice Address - Phone:843-357-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist