Provider Demographics
NPI:1790035137
Name:EICHORN, CHARLENE DENISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:DENISE
Last Name:EICHORN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W FRYE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4950
Mailing Address - Country:US
Mailing Address - Phone:888-694-7287
Mailing Address - Fax:
Practice Address - Street 1:2700 W FRYE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4950
Practice Address - Country:US
Practice Address - Phone:888-697-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS019294OtherPHARMACIST