Provider Demographics
NPI:1922377340
Name:CHAMPION, CAROL LOREE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LOREE
Last Name:CHAMPION
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 1:1700 BELVEDERE CT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2509
Mailing Address - Country:US
Mailing Address - Phone:901-274-0016
Mailing Address - Fax:
Practice Address - Street 1:1700 BELVEDERE CT
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2509
Practice Address - Country:US
Practice Address - Phone:901-274-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20916183500000X
FLPS44791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist