Provider Demographics
NPI:1316245905
Name:FULK, CHRISA FULCHER (PHARM D)
Entity type:Individual
Prefix:
First Name:CHRISA
Middle Name:FULCHER
Last Name:FULK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 N NC HIGHWAY 150
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9730
Mailing Address - Country:US
Mailing Address - Phone:335-764-2581
Mailing Address - Fax:
Practice Address - Street 1:12311 N NC HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9730
Practice Address - Country:US
Practice Address - Phone:335-764-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0186248Medicaid