Provider Demographics
NPI:1518173251
Name:GAUTHIER, CHARLYN C (RPH, CPH)
Entity Type:Individual
Prefix:
First Name:CHARLYN
Middle Name:C
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N CATTLEMEN RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6426
Mailing Address - Country:US
Mailing Address - Phone:941-341-9524
Mailing Address - Fax:
Practice Address - Street 1:300 N CATTLEMEN RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6426
Practice Address - Country:US
Practice Address - Phone:941-341-9524
Practice Address - Fax:941-341-9796
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27561183500000X
FLPU42571835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist