Healthcare Provider Details

I. General information

NPI: 1851722839
Provider Name (Legal Business Name): CHARLENE MCCORMACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLENE PHILLIPS

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 SOUTHWIND DR
JUNCTION CITY KS
66441-9041
US

IV. Provider business mailing address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-4670
  • Fax:
Mailing address:
  • Phone: 785-350-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH025114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: