Provider Demographics
NPI:1275129033
Name:NORRIS, CHARLES LEE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEE
Last Name:NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 NW LITTLE CAT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-4232
Mailing Address - Country:US
Mailing Address - Phone:850-973-3019
Mailing Address - Fax:850-973-2714
Practice Address - Street 1:407 E BASE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2769
Practice Address - Country:US
Practice Address - Phone:850-973-3019
Practice Address - Fax:850-973-2714
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS18861OtherPS18861