Provider Demographics
NPI:1720377179
Name:ANDERSON, CHARLES E (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 MARKET AVE N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1428
Mailing Address - Country:US
Mailing Address - Phone:330-456-0515
Mailing Address - Fax:330-456-1713
Practice Address - Street 1:3030 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1428
Practice Address - Country:US
Practice Address - Phone:330-456-0515
Practice Address - Fax:330-456-1713
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03310388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist