Individual
MS. CHARLDEEN JUSTICE BAGWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1460 LEE HWY, BRISTOL, VA 24201-2865
(276) 642-0738
Mailing address
170 FAIRVIEW ST, 1410 FAIRVIEW ST, GRUNDY, VA 24614-9415
(276) 935-8797
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0000034167
TN
183500000X
Pharmacist
011130
KY
183500000X
Pharmacist
Primary
0202004468
VA
183500000X
Pharmacist
RP0003356
WV
Other
Enumeration date
10/04/2006
Last updated
08/02/2010
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