Provider Demographics
NPI:1780221960
Name:MERRITT, CHARLENE FOSTER (BS, RPH)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:FOSTER
Last Name:MERRITT
Suffix:
Gender:F
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 W WHITE ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5007
Mailing Address - Country:US
Mailing Address - Phone:972-924-4220
Mailing Address - Fax:
Practice Address - Street 1:1325 W WHITE ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5007
Practice Address - Country:US
Practice Address - Phone:972-924-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist