Provider Demographics
NPI:1891835815
Name:LARBIE, CHARLES MARCELLUS
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARCELLUS
Last Name:LARBIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9528 WEBB CHAPEL RD
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4938
Mailing Address - Country:US
Mailing Address - Phone:214-528-7133
Mailing Address - Fax:
Practice Address - Street 1:9528 WEBB CHAPEL RD
Practice Address - Street 2:SUITE # 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4938
Practice Address - Country:US
Practice Address - Phone:214-528-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146744Medicaid