Provider Demographics
NPI:1649570441
Name:SMALLWOOD, CHARLES R III (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:SMALLWOOD
Suffix:III
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 1:4044 S ODESSA CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-7477
Mailing Address - Country:US
Mailing Address - Phone:303-284-8591
Mailing Address - Fax:
Practice Address - Street 1:4884 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-5152
Practice Address - Country:US
Practice Address - Phone:303-371-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist