Provider Demographics
NPI:1215243308
Name:MOLLER, CHARMAINE LESLEY (BACHELOR OF PHARMACY)
Entity type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:LESLEY
Last Name:MOLLER
Suffix:
Gender:F
Credentials:BACHELOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GRASS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3714
Mailing Address - Country:US
Mailing Address - Phone:530-885-9381
Mailing Address - Fax:530-823-8653
Practice Address - Street 1:420 GRASS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3714
Practice Address - Country:US
Practice Address - Phone:530-885-9381
Practice Address - Fax:530-823-8653
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist