Provider Demographics
NPI:1467594176
Name:STEWART, CHARLES MARTIN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MARTIN
Last Name:STEWART
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 1:3501 GANO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-5825
Mailing Address - Country:US
Mailing Address - Phone:281-753-8012
Mailing Address - Fax:
Practice Address - Street 1:3501 GANO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-5825
Practice Address - Country:US
Practice Address - Phone:281-753-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist