Provider Demographics
NPI:1417201096
Name:HUMPHREYS, CHARLES ERIC (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ERIC
Last Name:HUMPHREYS
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 1:1193 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1735
Mailing Address - Country:US
Mailing Address - Phone:478-746-8331
Mailing Address - Fax:478-254-8926
Practice Address - Street 1:1193 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1735
Practice Address - Country:US
Practice Address - Phone:478-746-8331
Practice Address - Fax:478-254-8926
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist