Provider Demographics
NPI:1679929913
Name:STAMPS, CHARLES TIMOTHY (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:TIMOTHY
Last Name:STAMPS
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 1:1098 SCHMIDT RD
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-8745
Mailing Address - Country:US
Mailing Address - Phone:601-248-6585
Mailing Address - Fax:
Practice Address - Street 1:820 BROOKWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2642
Practice Address - Country:US
Practice Address - Phone:601-833-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist