Provider Demographics
NPI:1861521395
Name:WARRENDAVIS, CHARLENE LAVERNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:LAVERNE
Last Name:WARRENDAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17613 AUBURN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1045
Mailing Address - Country:US
Mailing Address - Phone:301-570-4378
Mailing Address - Fax:
Practice Address - Street 1:1423 SULTAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9201
Practice Address - Country:US
Practice Address - Phone:301-619-4362
Practice Address - Fax:301-619-4480
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist