Provider Demographics
NPI:1275818775
Name:DAUMKE, CHARLENE M (RPH)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:M
Last Name:DAUMKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 SW PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1835
Mailing Address - Country:US
Mailing Address - Phone:772-879-0522
Mailing Address - Fax:772-871-9669
Practice Address - Street 1:692 SW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1835
Practice Address - Country:US
Practice Address - Phone:772-879-0522
Practice Address - Fax:772-871-9669
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist