Provider Demographics
NPI:1407121122
Name:HAMPTON, CHARLENE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:MARIE
Last Name:HAMPTON
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 1:9338 AUTUMN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5003
Mailing Address - Country:US
Mailing Address - Phone:907-336-2924
Mailing Address - Fax:907-336-2925
Practice Address - Street 1:9338 AUTUMN RIDGE CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5003
Practice Address - Country:US
Practice Address - Phone:907-336-2924
Practice Address - Fax:907-336-2925
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist