Provider Demographics
NPI:1477107621
Name:PULLINS, DERRICK LAVAURS JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:LAVAURS
Last Name:PULLINS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 GLENN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3515
Mailing Address - Country:US
Mailing Address - Phone:919-688-3081
Mailing Address - Fax:
Practice Address - Street 1:1525 GLENN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3515
Practice Address - Country:US
Practice Address - Phone:919-688-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80466183500000X
NC31232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist