Provider Demographics
NPI:1447316179
Name:UPCHURCH, GINA (RPH, MPH)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:RPH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 RIGSBEE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2186
Mailing Address - Country:US
Mailing Address - Phone:919-682-4962
Mailing Address - Fax:919-682-0444
Practice Address - Street 1:406 RIGSBEE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2186
Practice Address - Country:US
Practice Address - Phone:919-682-4962
Practice Address - Fax:919-682-0444
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94601835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric