Provider Demographics
NPI:1558538280
Name:CULPEPPER, CHARLES ROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROY
Last Name:CULPEPPER
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 1:803 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-1211
Mailing Address - Country:US
Mailing Address - Phone:706-454-5150
Mailing Address - Fax:706-454-5151
Practice Address - Street 1:803 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-1211
Practice Address - Country:US
Practice Address - Phone:706-454-5150
Practice Address - Fax:706-454-5151
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH008914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist