Provider Demographics
NPI:1952978538
Name:NAYLOR, CHARLES MICHAEL (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:NAYLOR
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:MICHAEL
Other - Last Name:NAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:360 MARTIN LUTHER KING JR BLVD N
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1712
Mailing Address - Country:US
Mailing Address - Phone:248-335-0602
Mailing Address - Fax:248-332-8960
Practice Address - Street 1:54 E BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2610
Practice Address - Country:US
Practice Address - Phone:248-335-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303035442183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician