Provider Demographics
NPI:1417034950
Name:GORE, CHARLES LENWOOD II (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LENWOOD
Last Name:GORE
Suffix:II
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 GLENRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2959
Mailing Address - Country:US
Mailing Address - Phone:859-881-3830
Mailing Address - Fax:
Practice Address - Street 1:951 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2151
Practice Address - Country:US
Practice Address - Phone:859-885-6094
Practice Address - Fax:859-885-2354
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist