Provider Demographics
NPI:1245512615
Name:NEBOLISA, STELLA C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:C
Last Name:NEBOLISA
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 1:1854 GEIBERGER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6224
Mailing Address - Country:US
Mailing Address - Phone:910-630-6653
Mailing Address - Fax:
Practice Address - Street 1:200 N BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3350
Practice Address - Country:US
Practice Address - Phone:910-436-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist