Provider Demographics
NPI:1477817716
Name:VINCENZES, CHARLOTTE
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:
Last Name:VINCENZES
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 1:955 SE BASELINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4207
Mailing Address - Country:US
Mailing Address - Phone:503-615-8384
Mailing Address - Fax:
Practice Address - Street 1:955 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4207
Practice Address - Country:US
Practice Address - Phone:503-615-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist