Provider Demographics
NPI:1629103577
Name:BEMBRY, CHARLES MAYNARD (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MAYNARD
Last Name:BEMBRY
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 1:2229 KEMP RD
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-5761
Mailing Address - Country:US
Mailing Address - Phone:850-539-5387
Mailing Address - Fax:
Practice Address - Street 1:112 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1620
Practice Address - Country:US
Practice Address - Phone:850-539-8080
Practice Address - Fax:850-539-3050
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist