Provider Demographics
NPI:1982922787
Name:CHILES, CAROLYN H (RPH)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:H
Last Name:CHILES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 RHODES AVE
Mailing Address - Street 2:SAME
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-5701
Mailing Address - Country:US
Mailing Address - Phone:361-537-0612
Mailing Address - Fax:361-758-8017
Practice Address - Street 1:101 E GOODNIGHT AVE
Practice Address - Street 2:SAME
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-1919
Practice Address - Country:US
Practice Address - Phone:361-758-9565
Practice Address - Fax:361-758-8017
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist