Individual
MRS. CHARMAINE DENISE MODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSCPHARM
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-7656
Mailing address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2275
(360) 414-7366
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00057349
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2016402
—
WA
Enumeration date
03/07/2007
Last updated
12/06/2018
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