Provider Demographics
NPI:1871845644
Name:DAVIS, CHARLES E (RPH, DPH, MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH, DPH, MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:G
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1128 TARRYTOWN LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3545
Mailing Address - Country:US
Mailing Address - Phone:803-794-1581
Mailing Address - Fax:803-794-3737
Practice Address - Street 1:106 JIMMY MARTIN CIR
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-9242
Practice Address - Country:US
Practice Address - Phone:803-794-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist