Provider Demographics
NPI:1275594095
Name:ST. CHARLES HEALTH COUNCIL, INC
Entity Type:Organization
Organization Name:ST. CHARLES HEALTH COUNCIL, INC
Other - Org Name:STONE MOUNTAIN HEALTH SERVICES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-546-5310
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:VA
Mailing Address - Zip Code:24248-0159
Mailing Address - Country:US
Mailing Address - Phone:276-445-4826
Mailing Address - Fax:276-546-3440
Practice Address - Street 1:HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:VA
Practice Address - Zip Code:24248-0159
Practice Address - Country:US
Practice Address - Phone:276-445-4826
Practice Address - Fax:276-546-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy