Provider Demographics
NPI:1114277852
Name:CHARLTON, SEKINAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEKINAH
Middle Name:
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SEKINAH
Other - Middle Name:
Other - Last Name:SAMADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2102 NEZ PERCE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4116
Mailing Address - Country:US
Mailing Address - Phone:208-743-4434
Mailing Address - Fax:
Practice Address - Street 1:2102 NEZ PERCE DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4116
Practice Address - Country:US
Practice Address - Phone:208-743-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60225984183500000X
IDE18570183500000X
IDP8337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist