Provider Demographics
NPI:1902157670
Name:KILLIAN, CHARLES FREDERICK (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 HOLLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2210
Mailing Address - Country:US
Mailing Address - Phone:919-682-9271
Mailing Address - Fax:919-688-6261
Practice Address - Street 1:1812 HOLLOWAY ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2210
Practice Address - Country:US
Practice Address - Phone:919-682-9271
Practice Address - Fax:919-688-6261
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5711OtherNC LICENSE NUMBER