Provider Demographics
NPI:1073117115
Name:BRICE, CHARLES WESLEY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WESLEY
Last Name:BRICE
Suffix:JR
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 1:3161 MOUNT MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8146
Mailing Address - Country:US
Mailing Address - Phone:724-627-8108
Mailing Address - Fax:724-627-5485
Practice Address - Street 1:3161 MOUNT MORRIS RD
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8146
Practice Address - Country:US
Practice Address - Phone:724-627-8108
Practice Address - Fax:724-627-5485
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040054L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist