Provider Demographics
NPI:1699377523
Name:JANAK, CHARLES ERWIN (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ERWIN
Last Name:JANAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:ERWIN
Other - Last Name:JANAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:358 COUNTY ROAD 171
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-5492
Mailing Address - Country:US
Mailing Address - Phone:979-732-0607
Mailing Address - Fax:
Practice Address - Street 1:2103 MILAM ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3013
Practice Address - Country:US
Practice Address - Phone:979-732-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy