Provider Demographics
NPI:1376660803
Name:CARAWAY, CHARLES JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:CARAWAY
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FRANK COLE RD
Mailing Address - Street 2:
Mailing Address - City:LONGVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70652-5024
Mailing Address - Country:US
Mailing Address - Phone:337-396-5686
Mailing Address - Fax:
Practice Address - Street 1:601 S PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4941
Practice Address - Country:US
Practice Address - Phone:337-463-7442
Practice Address - Fax:337-463-7442
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist