Provider Demographics
NPI:1407349939
Name:THIES, CHARAE S
Entity Type:Individual
Prefix:
First Name:CHARAE
Middle Name:S
Last Name:THIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5411
Mailing Address - Country:US
Mailing Address - Phone:251-645-8184
Mailing Address - Fax:251-645-4482
Practice Address - Street 1:7855 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5411
Practice Address - Country:US
Practice Address - Phone:251-645-8184
Practice Address - Fax:251-645-4482
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist