Provider Demographics
NPI:1730520990
Name:EBERT, CHRISTINE NICHOLAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:NICHOLAS
Last Name:EBERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8403
Mailing Address - Country:US
Mailing Address - Phone:336-782-5787
Mailing Address - Fax:
Practice Address - Street 1:340 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2881
Practice Address - Country:US
Practice Address - Phone:336-993-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist