Provider Demographics
NPI:1790077170
Name:CHARTERS, LORELEI MERCEDES (RPH)
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:MERCEDES
Last Name:CHARTERS
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:PO BOX 7709
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31418-7709
Mailing Address - Country:US
Mailing Address - Phone:912-966-1416
Mailing Address - Fax:912-966-1417
Practice Address - Street 1:516 W HWY 80
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-3108
Practice Address - Country:US
Practice Address - Phone:912-966-1416
Practice Address - Fax:912-966-1417
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA016448OtherSTATE LICENSE NUMBER