Provider Demographics
NPI:1922408095
Name:MYERS, CHARLES
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MYERS
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 1:11416 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3082
Mailing Address - Country:US
Mailing Address - Phone:301-230-9898
Mailing Address - Fax:301-984-1604
Practice Address - Street 1:11416 ROCKVILLE PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3082
Practice Address - Country:US
Practice Address - Phone:301-230-9898
Practice Address - Fax:301-984-1604
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist