Provider Demographics
NPI:1487029252
Name:FULLERTON, CHRISTINA LOUISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:LOUISE
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:106 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2426
Mailing Address - Country:US
Mailing Address - Phone:860-443-1244
Mailing Address - Fax:860-440-3330
Practice Address - Street 1:106 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2426
Practice Address - Country:US
Practice Address - Phone:860-443-1244
Practice Address - Fax:860-440-3330
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist