Provider Demographics
NPI:1750664082
Name:GRIFFIN, CHARLIE D (R PH)
Entity Type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:D
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4406
Mailing Address - Country:US
Mailing Address - Phone:714-377-3756
Mailing Address - Fax:714-846-7246
Practice Address - Street 1:4935 WARNER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649
Practice Address - Country:UM
Practice Address - Phone:714-377-3756
Practice Address - Fax:714-846-7246
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist