Charles L Davenport Valid NPI

Individual provider · Pharmacist · Mableton, GA

NPI

1104038686

Type

Individual (Type 1)

Primary specialty

Pharmacist

Specialty group

Pharmacy Service Providers

Taxonomy code

183500000X

License number

GA017346 (GA)

Sex

Male

Sole proprietor

Yes

Enumerated

2007-05-04

Last updated

2007-07-08