Provider Demographics
NPI:1114247038
Name:LAUREL, CHARLENE FLORINA (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:FLORINA
Last Name:LAUREL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:DAVID
Other - Last Name:FLORINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5630 COTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3696
Mailing Address - Country:US
Mailing Address - Phone:408-600-3722
Mailing Address - Fax:408-600-3732
Practice Address - Street 1:5630 COTTLE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3696
Practice Address - Country:US
Practice Address - Phone:408-600-3722
Practice Address - Fax:408-600-3732
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60241441183500000X
CARPH 66979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist