Provider Demographics
NPI:1063012714
Name:STRECKER, CHARLOTTE (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:
Last Name:STRECKER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PROVIDENCE PL
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757
Mailing Address - Country:US
Mailing Address - Phone:504-330-3390
Mailing Address - Fax:
Practice Address - Street 1:6801 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4733
Practice Address - Country:US
Practice Address - Phone:903-581-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist