Provider Demographics
NPI:1841601739
Name:DAVIS, CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 W. PIERSON RD. G
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504
Mailing Address - Country:US
Mailing Address - Phone:810-230-6033
Mailing Address - Fax:810-230-6065
Practice Address - Street 1:4333 W. PIERSON RD. G
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504
Practice Address - Country:US
Practice Address - Phone:910-230-6033
Practice Address - Fax:810-230-6065
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020239391835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy