Provider Demographics
NPI:1619510385
Name:CHARLES, HESTER L
Entity Type:Individual
Prefix:MR
First Name:HESTER
Middle Name:L
Last Name:CHARLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3232 E BIRCHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-9682
Mailing Address - Country:US
Mailing Address - Phone:480-213-3384
Mailing Address - Fax:
Practice Address - Street 1:3232 E BIRCHWOOD PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-9682
Practice Address - Country:US
Practice Address - Phone:480-213-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies