Provider Demographics
NPI:1356415947
Name:FAIRLEY, VALLA CHRISTINA (BS-PHARMACIST-PHARM)
Entity type:Individual
Prefix:
First Name:VALLA
Middle Name:CHRISTINA
Last Name:FAIRLEY
Suffix:
Gender:F
Credentials:BS-PHARMACIST-PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILFORD HALL LOOP BLDG 4554
Mailing Address - Street 2:
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:V. CHRISTINA FAIRLEY
Practice Address - Street 2:1100 WILFORD HALL LOOP, BLDG 4554 RM 1B074
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist