Provider Demographics
NPI:1215162375
Name:PACE, CHARLES BROWNLOW (PHARMACIST)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BROWNLOW
Last Name:PACE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3410
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-3410
Mailing Address - Country:US
Mailing Address - Phone:252-247-6933
Mailing Address - Fax:252-247-2902
Practice Address - Street 1:915 B WEST FORT MACON RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NC
Practice Address - Zip Code:28512
Practice Address - Country:US
Practice Address - Phone:252-247-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist