Provider Demographics
NPI:1508043712
Name:CALLIHAN, CHARLES PHILLIP SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PHILLIP
Last Name:CALLIHAN
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3380 TRICKUM RD
Mailing Address - Street 2:BLDG. 500, 104
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3680
Mailing Address - Country:US
Mailing Address - Phone:678-236-0403
Mailing Address - Fax:678-236-0415
Practice Address - Street 1:3380 TRICKUM RD
Practice Address - Street 2:BLDG. 500, 104
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3680
Practice Address - Country:US
Practice Address - Phone:678-236-0403
Practice Address - Fax:678-236-0415
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist