Provider Demographics
NPI:1588033112
Name:SIR CHARLES PHARMACY, INC.
Entity Type:Organization
Organization Name:SIR CHARLES PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:AYEBAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:954-253-1036
Mailing Address - Street 1:17560 NW 27TH AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4014
Mailing Address - Country:US
Mailing Address - Phone:305-705-3415
Mailing Address - Fax:
Practice Address - Street 1:17560 NW 27TH AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4014
Practice Address - Country:US
Practice Address - Phone:305-705-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy