Provider Demographics
NPI:1336460542
Name:COLEY, CHARLES CURTIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CURTIS
Last Name:COLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3905
Mailing Address - Country:US
Mailing Address - Phone:423-752-8104
Mailing Address - Fax:423-752-9197
Practice Address - Street 1:110 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3905
Practice Address - Country:US
Practice Address - Phone:423-752-8104
Practice Address - Fax:423-752-9197
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist