Provider Demographics
NPI:1255476834
Name:JUSTUS, CHARLES SCOTT (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:SCOTT
Last Name:JUSTUS
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 1:148 OAK HILL LN
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24280-3591
Mailing Address - Country:US
Mailing Address - Phone:276-880-2112
Mailing Address - Fax:
Practice Address - Street 1:305 OLD KENTUCKY TPK
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-964-0555
Practice Address - Fax:276-964-2999
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist