Provider Demographics
NPI:1205915865
Name:MIDDLECOFF, CHARNELL WHITFIELD III (DPH)
Entity type:Individual
Prefix:DR
First Name:CHARNELL
Middle Name:WHITFIELD
Last Name:MIDDLECOFF
Suffix:III
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068
Mailing Address - Country:US
Mailing Address - Phone:901-465-9020
Mailing Address - Fax:
Practice Address - Street 1:13092 N MAIN STREET
Practice Address - Street 2:SUPER DRUGS
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1421
Practice Address - Country:US
Practice Address - Phone:901-465-9888
Practice Address - Fax:901-465-6906
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist