Provider Demographics
NPI:1386744498
Name:PAUL-AVILES, FERN E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FERN
Middle Name:E
Last Name:PAUL-AVILES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2610 MERRYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6716
Mailing Address - Country:US
Mailing Address - Phone:704-512-7631
Mailing Address - Fax:704-512-7630
Practice Address - Street 1:4400 GOLF ACRES DR
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5923
Practice Address - Country:US
Practice Address - Phone:704-512-7631
Practice Address - Fax:704-512-7630
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112731835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy