Provider Demographics
NPI:1598231409
Name:LOCKHART, CHARLES PETER (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PETER
Last Name:LOCKHART
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 1:28 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3325
Mailing Address - Country:US
Mailing Address - Phone:413-536-5483
Mailing Address - Fax:413-552-3180
Practice Address - Street 1:28 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3325
Practice Address - Country:US
Practice Address - Phone:413-536-5483
Practice Address - Fax:413-552-3180
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0009514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH24747OtherPHARMACY LICENSE
CTPCT.0009514OtherPHARMACY LICENSE