Provider Demographics
NPI:1629015623
Name:ADCOCK, CHARLOTTE CORKRAN (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:CORKRAN
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-4039
Mailing Address - Country:US
Mailing Address - Phone:731-253-8919
Mailing Address - Fax:731-253-7304
Practice Address - Street 1:139 CHURCH ST
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1374
Practice Address - Country:US
Practice Address - Phone:731-253-7411
Practice Address - Fax:731-253-7304
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist