Provider Demographics
NPI:1770799462
Name:JAWORSKI, CHARLOTTE ANN (RPH)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ANN
Last Name:JAWORSKI
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 1:5255 KELLEN LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2739
Mailing Address - Country:US
Mailing Address - Phone:248-855-0532
Mailing Address - Fax:
Practice Address - Street 1:2554 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3352
Practice Address - Country:US
Practice Address - Phone:248-288-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist