Provider Demographics
NPI:1740414309
Name:BAHR, CHARLES MARTIN (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARTIN
Last Name:BAHR
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 1:3200 CAYON LAKE DRIVE
Mailing Address - Street 2:PHS INDIAN HOSPITAL
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-355-2309
Mailing Address - Fax:
Practice Address - Street 1:3200 CAYON LAKE DRIVE ROOM 235
Practice Address - Street 2:PHS INDIAN HOSPITAL
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-355-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist