Provider Demographics
NPI:1275083032
Name:BUJULA, DIANA (RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BUJULA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:BUJULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1441 JOSIE LN
Mailing Address - Street 2:#203
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0168
Mailing Address - Country:US
Mailing Address - Phone:214-500-2366
Mailing Address - Fax:
Practice Address - Street 1:2580 COURT DR
Practice Address - Street 2:CVS PHARMACY
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2139
Practice Address - Country:US
Practice Address - Phone:704-810-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist