Provider Demographics
NPI:1356678825
Name:DWYER, CHARLES JACKSON
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JACKSON
Last Name:DWYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3204
Mailing Address - Country:US
Mailing Address - Phone:828-274-7560
Mailing Address - Fax:828-274-8767
Practice Address - Street 1:1835 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3204
Practice Address - Country:US
Practice Address - Phone:828-274-7560
Practice Address - Fax:828-274-8767
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18022183500000X
AZS009791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist