Provider Demographics
NPI:1538722145
Name:FAIRFAX, CHARLENE (RPH)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:FAIRFAX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EVARTS ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1005
Mailing Address - Country:US
Mailing Address - Phone:202-904-6560
Mailing Address - Fax:
Practice Address - Street 1:441 4TH ST NW STE 900
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2714
Practice Address - Country:US
Practice Address - Phone:202-442-9076
Practice Address - Fax:202-722-5685
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA2782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist