Provider Demographics
NPI:1720369226
Name:TIVEY, CHARLOTTE DENISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:DENISE
Last Name:TIVEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 S HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3946
Mailing Address - Country:US
Mailing Address - Phone:386-328-6787
Mailing Address - Fax:386-328-8641
Practice Address - Street 1:719 S HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3946
Practice Address - Country:US
Practice Address - Phone:386-328-6787
Practice Address - Fax:386-328-8641
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016165183500000X
FLPS25587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist