Provider Demographics
NPI:1861719783
Name:HARTOGH, CHARNINE LOUISE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHARNINE
Middle Name:LOUISE
Last Name:HARTOGH
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 1:2020 N RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4600
Mailing Address - Country:US
Mailing Address - Phone:909-873-2835
Mailing Address - Fax:909-873-2837
Practice Address - Street 1:2020 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4600
Practice Address - Country:US
Practice Address - Phone:909-873-2835
Practice Address - Fax:909-873-2837
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 56721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist