Provider Demographics
NPI:1639583958
Name:CHARLESTON, TARINA
Entity Type:Individual
Prefix:
First Name:TARINA
Middle Name:
Last Name:CHARLESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 ROCKVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1136
Mailing Address - Country:US
Mailing Address - Phone:301-340-2686
Mailing Address - Fax:301-340-2847
Practice Address - Street 1:799 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1136
Practice Address - Country:US
Practice Address - Phone:301-340-2686
Practice Address - Fax:301-340-2847
Is Sole Proprietor?:No
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist