Provider Demographics
NPI:1225216260
Name:COLQUITT, CHARLIE WALLER (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:WALLER
Last Name:COLQUITT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 22ND ST SO
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712
Mailing Address - Country:US
Mailing Address - Phone:727-821-6701
Mailing Address - Fax:
Practice Address - Street 1:1344 22ND ST SO
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712
Practice Address - Country:US
Practice Address - Phone:727-821-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0030592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist