Provider Demographics
NPI:1104800168
Name:MARSH, CHARLES CLIFTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CLIFTON
Last Name:MARSH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 S 106TH CIR
Mailing Address - Street 2:ATTN: NPI
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5871
Mailing Address - Country:US
Mailing Address - Phone:479-478-6180
Mailing Address - Fax:479-478-6270
Practice Address - Street 1:3106 S 106TH CIR
Practice Address - Street 2:ATTN: NPI
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5871
Practice Address - Country:US
Practice Address - Phone:479-478-6180
Practice Address - Fax:479-478-6270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR67221835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy