Provider Demographics
NPI:1225562796
Name:COLTON, CHARLENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:COLTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21572 PLANO TRABUCO RD
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3465
Mailing Address - Country:US
Mailing Address - Phone:949-589-3792
Mailing Address - Fax:949-589-2705
Practice Address - Street 1:21572 PLANO TRABUCO RD
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3465
Practice Address - Country:US
Practice Address - Phone:949-589-3792
Practice Address - Fax:949-589-2705
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist