Provider Demographics
NPI:1295033686
Name:ROZANOV-OVERHOLT, CHARMAINE B (PHD, RPH)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:B
Last Name:ROZANOV-OVERHOLT
Suffix:
Gender:F
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 CINNAMON WAY
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7263
Mailing Address - Country:US
Mailing Address - Phone:336-764-8389
Mailing Address - Fax:336-764-8389
Practice Address - Street 1:3440 ROBINHOOD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4702
Practice Address - Country:US
Practice Address - Phone:336-768-6610
Practice Address - Fax:336-768-6201
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18092183500000X
OH03326788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist