Provider Demographics
NPI:1336476191
Name:SUTTLE, CHARLES G (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:SUTTLE
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 1:8206 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1904
Mailing Address - Country:US
Mailing Address - Phone:281-550-2169
Mailing Address - Fax:281-550-9069
Practice Address - Street 1:8206 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1904
Practice Address - Country:US
Practice Address - Phone:281-550-2169
Practice Address - Fax:281-550-9069
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist