Provider Demographics
NPI:1760770499
Name:WHITEHEAD, CHARLES M (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:WHITEHEAD
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 1:6525 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-0879
Mailing Address - Country:US
Mailing Address - Phone:336-824-1276
Mailing Address - Fax:336-824-1285
Practice Address - Street 1:6525 JORDAN RD
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-0879
Practice Address - Country:US
Practice Address - Phone:336-824-1276
Practice Address - Fax:336-824-1285
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist