Provider Demographics
NPI:1427370253
Name:DILZER, CHARLES H (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:DILZER
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:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-0231
Mailing Address - Country:US
Mailing Address - Phone:518-891-3132
Mailing Address - Fax:518-891-6811
Practice Address - Street 1:277 BROADWAY
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1132
Practice Address - Country:US
Practice Address - Phone:518-891-3132
Practice Address - Fax:518-891-6811
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist