Individual
CHARLES DELVON PICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
7019 N LITCHFIELD AVE, LUKE AFB, 56/AMDS, LUKE AFB, AZ 85309
(623) 856-7527
Mailing address
16240 W PIMA ST, GOODYEAR, AZ 85338-7927
(480) 233-5021
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
01/31/2011
Last updated
08/30/2011
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