Provider Demographics
NPI:1639496763
Name:HORTON, CHARLES LEE SR
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEE
Last Name:HORTON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-5138
Mailing Address - Country:US
Mailing Address - Phone:903-874-6546
Mailing Address - Fax:903-874-7569
Practice Address - Street 1:201 S 15TH ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-5138
Practice Address - Country:US
Practice Address - Phone:903-874-6546
Practice Address - Fax:903-874-7569
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist