Provider Demographics
NPI:1215077474
Name:CHARLIE'S PHARMACY INC.
Entity type:Organization
Organization Name:CHARLIE'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARCELLUS
Authorized Official - Last Name:LARBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-528-7133
Mailing Address - Street 1:9528 WEBB CHAPEL ROAD
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4938
Mailing Address - Country:US
Mailing Address - Phone:214-528-7133
Mailing Address - Fax:214-528-7134
Practice Address - Street 1:9528 WEBB CHAPEL RD
Practice Address - Street 2:SUITE # 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4938
Practice Address - Country:US
Practice Address - Phone:214-528-7133
Practice Address - Fax:214-528-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145251Medicaid