Provider Demographics
NPI:1972794915
Name:BOENIG, CHARLES GIBSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GIBSON
Last Name:BOENIG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 GUINEVERE LN
Mailing Address - Street 2:
Mailing Address - City:POMFRET
Mailing Address - State:MD
Mailing Address - Zip Code:20675-3205
Mailing Address - Country:US
Mailing Address - Phone:301-934-4947
Mailing Address - Fax:
Practice Address - Street 1:4415 GUINEVERE LN
Practice Address - Street 2:
Practice Address - City:POMFRET
Practice Address - State:MD
Practice Address - Zip Code:20675-3205
Practice Address - Country:US
Practice Address - Phone:301-934-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist