Provider Demographics
NPI:1942314158
Name:MAULDIN, CHARLES L (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:L
Last Name:MAULDIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 WW RAY CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-5023
Mailing Address - Country:US
Mailing Address - Phone:940-683-2950
Mailing Address - Fax:940-683-8059
Practice Address - Street 1:709 WW RAY CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-5023
Practice Address - Country:US
Practice Address - Phone:940-683-2950
Practice Address - Fax:940-683-8059
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21376OtherRPH