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Individual
THERESA FAIRFAX
Active
Individual
THERESA FAIRFAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI02788100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497850721
NPI
—
Enumeration date
12/10/2020
Last updated
12/10/2020
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