Provider Demographics
NPI:1700226784
Name:WILLIS, CHRISTAL ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:ELIZABETH
Last Name:WILLIS
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 1:901 YADKINVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2033
Mailing Address - Country:US
Mailing Address - Phone:336-751-2499
Mailing Address - Fax:336-751-5113
Practice Address - Street 1:901 YADKINVILLE RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2033
Practice Address - Country:US
Practice Address - Phone:336-751-2499
Practice Address - Fax:336-751-5113
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist