Provider Demographics
NPI:1760002463
Name:BIRKLAND, CHARLES ARTHUR
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ARTHUR
Last Name:BIRKLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1704
Mailing Address - Country:US
Mailing Address - Phone:712-336-6510
Mailing Address - Fax:
Practice Address - Street 1:1500 18TH ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1026
Practice Address - Country:US
Practice Address - Phone:712-336-4551
Practice Address - Fax:712-336-4562
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist