MEDICARE: CHARLOTTE CREAHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS25204	FL

General Provider Information

NPI Number	:	1336553759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE CREAHAN

Provider Business Mailing Address
First Line	:	8814 C PALAFOX HWY
Second Line	:	ENSLEY PHARMACY
City	:	PENSCOLA
State	:	FL
Zip	:	32534
Country	:	US
Telephone Number	:	850-473-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	8814 C PALAFOX HWY
Second Line	:	ENSLEY PHARMACY
City	:	PENSCOLA
State	:	FL
Zip	:	32534
Country	:	US
Telephone Number	:	850-473-0428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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Directions to “ CHARLOTTE CREAHAN ” Practice Location

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