Provider Demographics
NPI:1861833220
Name:CHILDRESS, REBECCA HILARY (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HILARY
Last Name:CHILDRESS
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 1:200 N LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3013
Mailing Address - Country:US
Mailing Address - Phone:919-383-5591
Mailing Address - Fax:
Practice Address - Street 1:200 N LASALLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3013
Practice Address - Country:US
Practice Address - Phone:919-383-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist