Healthcare Provider Details

I. General information

NPI: 1407349939
Provider Name (Legal Business Name): CHARAE S THIES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2018
Last Update Date: 06/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 MOFFETT RD
SEMMES AL
36575-5411
US

IV. Provider business mailing address

7855 MOFFETT RD
SEMMES AL
36575-5411
US

V. Phone/Fax

Practice location:
  • Phone: 251-645-8184
  • Fax: 251-645-4482
Mailing address:
  • Phone: 251-645-8184
  • Fax: 251-645-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12094
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: