Provider Demographics
NPI:1457635039
Name:MONTANI, CHARLES A JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:MONTANI
Suffix:JR
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 1:97 LONG RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1267
Mailing Address - Country:US
Mailing Address - Phone:636-519-7014
Mailing Address - Fax:636-519-7633
Practice Address - Street 1:97 LONG RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1267
Practice Address - Country:US
Practice Address - Phone:636-519-7014
Practice Address - Fax:636-519-7633
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist