Provider Demographics
NPI:1063706935
Name:SERGENT, CHARLES EDWARD (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:SERGENT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 GREENBRIER PKWY
Mailing Address - Street 2:TARGET T-1021
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0605
Mailing Address - Country:US
Mailing Address - Phone:757-547-5802
Mailing Address - Fax:757-547-5802
Practice Address - Street 1:1316 GREENBRIER PKWY
Practice Address - Street 2:TARGET T-1021
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0605
Practice Address - Country:US
Practice Address - Phone:757-547-5802
Practice Address - Fax:757-547-5802
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist