Provider Demographics
NPI:1235408238
Name:STATON, CHARLIE LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:LEE
Last Name:STATON
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 1:1019 LISCHEY AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5704
Mailing Address - Country:US
Mailing Address - Phone:256-490-5152
Mailing Address - Fax:
Practice Address - Street 1:1019 LISCHEY AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5704
Practice Address - Country:US
Practice Address - Phone:256-490-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000033771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist