Provider Demographics
NPI:1659396174
Name:DUTCHER, CHARLES ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLEN
Last Name:DUTCHER
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 1:660 N. MAIN
Mailing Address - Street 2:P.O. BOX 919
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-0919
Mailing Address - Country:US
Mailing Address - Phone:928-536-2044
Mailing Address - Fax:
Practice Address - Street 1:660 N. MAIN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939-0919
Practice Address - Country:US
Practice Address - Phone:928-536-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ122862OtherAHCCCS ID
AZ0319865OtherNCPDP