Provider Demographics
NPI:1568641645
Name:STACHOWIAK, CHARLES PATRICK (RPH, CRPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PATRICK
Last Name:STACHOWIAK
Suffix:
Gender:M
Credentials:RPH, CRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 MONDRAGON DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6560
Mailing Address - Country:US
Mailing Address - Phone:813-484-1740
Mailing Address - Fax:
Practice Address - Street 1:4602 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2626
Practice Address - Country:US
Practice Address - Phone:813-877-9700
Practice Address - Fax:813-877-2300
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist