Provider Demographics
NPI:1497366447
Name:CHARLES, ANDRE RAWLE (RPH)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:RAWLE
Last Name:CHARLES
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 1:4111 PARSONS BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1920
Mailing Address - Country:US
Mailing Address - Phone:347-276-7037
Mailing Address - Fax:
Practice Address - Street 1:1332 COMMERCE AVE FRNT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3612
Practice Address - Country:US
Practice Address - Phone:347-612-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist