Provider Demographics
NPI:1932332947
Name:EPPINGA, CHARMAINE DENISE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:CHARMAINE
Middle Name:DENISE
Last Name:EPPINGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4853
Mailing Address - Country:US
Mailing Address - Phone:505-865-2933
Mailing Address - Fax:505-865-9584
Practice Address - Street 1:1861 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4853
Practice Address - Country:US
Practice Address - Phone:505-865-2933
Practice Address - Fax:505-865-9584
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist