Provider Demographics
NPI:1417233032
Name:NAKANO, CHARLES S (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:S
Last Name:NAKANO
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 1:137 EGRET LN
Mailing Address - Street 2:
Mailing Address - City:GUADALUPE
Mailing Address - State:CA
Mailing Address - Zip Code:93434-1805
Mailing Address - Country:US
Mailing Address - Phone:805-343-4029
Mailing Address - Fax:
Practice Address - Street 1:2399 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7832
Practice Address - Country:US
Practice Address - Phone:805-928-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist