Provider Demographics
NPI:1174692107
Name:JOINER, CHARLES DAVID JR (PHARMACIST)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:JOINER
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PAINE AVE
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1239
Mailing Address - Country:US
Mailing Address - Phone:256-974-9024
Mailing Address - Fax:256-905-0049
Practice Address - Street 1:22747 AL HWY 24 STE D
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650
Practice Address - Country:US
Practice Address - Phone:256-974-9024
Practice Address - Fax:256-905-0049
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10877OtherPHARMACY LICENSE