Provider Demographics
NPI:1104977818
Name:DAVIS, CHARLOTTE YVONNE (R PH)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:YVONNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 FANNIN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5659
Mailing Address - Country:US
Mailing Address - Phone:817-468-8789
Mailing Address - Fax:
Practice Address - Street 1:7460 ARNOLD ST STE 126
Practice Address - Street 2:
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-9040
Practice Address - Country:US
Practice Address - Phone:405-739-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist