Provider Demographics
NPI:1659696318
Name:GEORGE, CHARLES M (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:GEORGE
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 1:58 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1240
Mailing Address - Country:US
Mailing Address - Phone:716-542-6300
Mailing Address - Fax:716-542-6664
Practice Address - Street 1:58 MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-1240
Practice Address - Country:US
Practice Address - Phone:716-542-6300
Practice Address - Fax:716-542-6664
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist