Provider Demographics
NPI:1336553759
Name:CREAHAN, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:CREAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8814 C PALAFOX HWY
Mailing Address - Street 2:ENSLEY PHARMACY
Mailing Address - City:PENSCOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534
Mailing Address - Country:US
Mailing Address - Phone:850-473-0428
Mailing Address - Fax:
Practice Address - Street 1:8814 C PALAFOX HWY
Practice Address - Street 2:ENSLEY PHARMACY
Practice Address - City:PENSCOLA
Practice Address - State:FL
Practice Address - Zip Code:32534
Practice Address - Country:US
Practice Address - Phone:850-473-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist