Provider Demographics
NPI:1215213699
Name:FULLER, CHRISTINA ELAINE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ELAINE
Last Name:FULLER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 W FIRETOWER RD
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-7724
Mailing Address - Country:US
Mailing Address - Phone:304-654-1723
Mailing Address - Fax:910-577-5399
Practice Address - Street 1:175 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:MIDWAY PARK
Practice Address - State:NC
Practice Address - Zip Code:28544-1444
Practice Address - Country:US
Practice Address - Phone:910-577-7561
Practice Address - Fax:910-577-5399
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist