Provider Demographics
NPI:1063798916
Name:CHARLESTHAM, CHERRY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHERRY
Middle Name:
Last Name:CHARLESTHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4653 CARMEL MOUNTAIN RD
Mailing Address - Street 2:STE. 308-414
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6650
Mailing Address - Country:US
Mailing Address - Phone:858-578-7267
Mailing Address - Fax:858-578-7502
Practice Address - Street 1:10740 WESTVIEW PKWY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2962
Practice Address - Country:US
Practice Address - Phone:858-578-7267
Practice Address - Fax:858-578-7502
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist