Provider Demographics
NPI:1306207857
Name:CHARLES, CORALIE LAROCHE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CORALIE
Middle Name:LAROCHE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CORALIE
Other - Middle Name:
Other - Last Name:LAROCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6094 MAGGIES CIR
Mailing Address - Street 2:UNIT 112
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8524
Mailing Address - Country:US
Mailing Address - Phone:786-214-0660
Mailing Address - Fax:
Practice Address - Street 1:6094 MAGGIES CIR
Practice Address - Street 2:UNIT 112
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8524
Practice Address - Country:US
Practice Address - Phone:786-214-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist