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DR. CHARLES L DAVENPORT

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1104038686

Individual Registrant:
DR. CHARLES L DAVENPORT 
Gender: M
Sole Proprietor

Location and contact information for practice:
558 IVEY WAY S.E.  MABLETON, GA 30126 US
Tel: 678-575-8701  Fax: --

Contact information for business:
558 IVEY WAY S.E.  MABLETON, GA 30126 US
Tel: 678-575-8701  Fax: --

Registration Information:
NPI: 1104038686
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
GAGA017346

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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