Provider Demographics
NPI:1770905168
Name:LEROUX, CHARLOTTE (BPHARM, PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:
Last Name:LEROUX
Suffix:
Gender:F
Credentials:BPHARM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 E WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0109
Mailing Address - Country:US
Mailing Address - Phone:602-561-6006
Mailing Address - Fax:
Practice Address - Street 1:6150 S 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5004
Practice Address - Country:US
Practice Address - Phone:602-243-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ13050OtherPHARMACY BOARD OF ARIZONA