Provider Demographics
NPI:1124743737
Name:FOGUE, CHRISTELLE ELISE KAPTUE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTELLE ELISE
Middle Name:KAPTUE
Last Name:FOGUE
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 1:12927 TOURMALINE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5351
Mailing Address - Country:US
Mailing Address - Phone:301-272-0562
Mailing Address - Fax:
Practice Address - Street 1:3908 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-4708
Practice Address - Country:US
Practice Address - Phone:434-846-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist