Provider Demographics
NPI:1336402791
Name:RICH, CHARIS OPHELIA (RPHT)
Entity Type:Individual
Prefix:MS
First Name:CHARIS
Middle Name:OPHELIA
Last Name:RICH
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 EAST GONZALES ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:32503
Mailing Address - Country:UM
Mailing Address - Phone:850-361-7308
Mailing Address - Fax:
Practice Address - Street 1:5149 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8756
Practice Address - Country:US
Practice Address - Phone:850-416-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT24328183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician