Provider Demographics
NPI:1962001016
Name:GUERRERO, CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COHUTTA DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-7906
Mailing Address - Country:US
Mailing Address - Phone:770-853-9540
Mailing Address - Fax:
Practice Address - Street 1:3139 HIGHWAY 278 NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2301
Practice Address - Country:US
Practice Address - Phone:770-787-4041
Practice Address - Fax:770-787-8325
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0191941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist