Provider Demographics
NPI:1306627229
Name:GLINES, CHARLETTE JANELL (PST)
Entity type:Individual
Prefix:
First Name:CHARLETTE
Middle Name:JANELL
Last Name:GLINES
Suffix:
Gender:F
Credentials:PST
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 4512
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-4008
Mailing Address - Country:US
Mailing Address - Phone:509-567-5873
Mailing Address - Fax:509-398-9389
Practice Address - Street 1:6241 SHALE ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-7843
Practice Address - Country:US
Practice Address - Phone:509-619-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60346272246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy