Provider Demographics
NPI:1982145090
Name:SMITH, CHARLES KERSHAW (PHARMD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KERSHAW
Last Name:SMITH
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 1:86TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 3215
Mailing Address - City:RAMSTEIN AB
Mailing Address - State:APO AE
Mailing Address - Zip Code:09094
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86TH MEDICAL GROUP
Practice Address - Street 2:UNIT 3215
Practice Address - City:RAMSTEIN AB
Practice Address - State:APO AE
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:813-943-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist