Provider Demographics
NPI:1194356626
Name:OLICK, CHARLAMAGNE C
Entity Type:Individual
Prefix:
First Name:CHARLAMAGNE
Middle Name:C
Last Name:OLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:KWETHLUK
Mailing Address - State:AK
Mailing Address - Zip Code:99621
Mailing Address - Country:US
Mailing Address - Phone:907-757-6627
Mailing Address - Fax:907-757-6626
Practice Address - Street 1:49 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:KWETHLUK
Practice Address - State:AK
Practice Address - Zip Code:99621
Practice Address - Country:US
Practice Address - Phone:907-757-6627
Practice Address - Fax:907-757-6626
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker