Provider Demographics
NPI:1215222351
Name:ANCHETA, CHARLENE F (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:F
Last Name:ANCHETA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3804 METRO DR
Mailing Address - Street 2:T2454
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7732
Mailing Address - Country:US
Mailing Address - Phone:712-309-3381
Mailing Address - Fax:712-309-3391
Practice Address - Street 1:3804 METRO DR
Practice Address - Street 2:T2454
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7732
Practice Address - Country:US
Practice Address - Phone:712-309-3381
Practice Address - Fax:712-309-3391
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12978183500000X
IA21345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist