Provider Demographics
NPI:1184826398
Name:WEBSTER, CHARLES THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
Last Name:WEBSTER
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 1:157 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-5231
Mailing Address - Country:US
Mailing Address - Phone:205-695-9154
Mailing Address - Fax:
Practice Address - Street 1:1116 2ND AVE NE
Practice Address - Street 2:FAYETTE SQUARE SHOPPING CENTER
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555
Practice Address - Country:US
Practice Address - Phone:205-932-5921
Practice Address - Fax:205-932-7910
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist