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General NPI Number Information
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NPI Number | 1356415947
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Entity Type | Individual
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Provider Name | VALLA CHRISTINA FAIRLEY BS-PHARMACIST-PHARM
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | V. CHRISTINA FAIRLEY 1100 WILFORD HALL LOOP, BLDG 4554 RM 1B074
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City | SAN ANTONIO
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State | TX
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Zip | 78236
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Country | US
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Telephone | 210-292-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILFORD HALL LOOP BLDG 4554
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City | LACKLAND AFB
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State | TX
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Zip | 78236-5638
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 33773
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License Number State | TX
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