Provider Demographics
NPI:1144723651
Name:GOLLA, CHRISTINE (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GOLLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 HOPGOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-1414
Mailing Address - Country:US
Mailing Address - Phone:615-387-7023
Mailing Address - Fax:
Practice Address - Street 1:7100 HOPGOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-1414
Practice Address - Country:US
Practice Address - Phone:615-387-7023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist