Charnell Whitfield Middlecoff III, DPH
Individual provider Active NPI Pharmacist · Somerville, TN
NPI 1205915865 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205915865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 3438 (TN)
- Practice address
- 13092 N Main Street
Super Drugs
Somerville, TN 38068-1421 - Phone
- (901) 465-9888
- Fax
- (901) 465-6906
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3438 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 3438 | TN | Yes |
Addresses
Primary practice location
13092 N Main Street
Super Drugs
Somerville, TN 38068-1421
Mailing address
145 Country Club Rd
Somerville, TN 38068
Phone (901) 465-9020
Other providers in Somerville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.