MEDICARE: CHARLIE'S PHARMACY ( DME )

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528293867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLIE'S PHARMACY ( DME )

Provider Business Mailing Address
First Line	:	9528 WEBB CHAPEL ROAD,
Second Line	:	SUITE # 110
City	:	DALLAS
State	:	TX
Zip	:	75220-2408
Country	:	US
Telephone Number	:	214-528-7133
Fax Number	:	214-528-7134

Provider Business Practice Location Address
First Line	:	9528 WEBB CHAPEL RD
Second Line	:	SUITE # 110
City	:	DALLAS
State	:	TX
Zip	:	75220-4938
Country	:	US
Telephone Number	:	214-528-7133
Fax Number	:	214-528-7134

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	CHARLES LARBIE
Credential	:
Telephone Number	:	214-528-7133

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	01/28/2011

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Directions to “CHARLIE'S PHARMACY ( DME ) ” Practice Location

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