Provider Demographics
NPI:1649549734
Name:TULLY, CHRISTINE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:TULLY
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 1:12 SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1611
Mailing Address - Country:US
Mailing Address - Phone:860-673-4265
Mailing Address - Fax:
Practice Address - Street 1:12 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1611
Practice Address - Country:US
Practice Address - Phone:860-673-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist