Provider Demographics
NPI:1316329014
Name:CHRG GROUP LLC
Entity type:Organization
Organization Name:CHRG GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEROLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-213-5453
Mailing Address - Street 1:36181 E LAKE RD
Mailing Address - Street 2:# 315
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3142
Mailing Address - Country:US
Mailing Address - Phone:718-213-5453
Mailing Address - Fax:
Practice Address - Street 1:33915 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2628
Practice Address - Country:US
Practice Address - Phone:718-213-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH291763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy