Provider Demographics
NPI:1790074284
Name:STOVER, CHARLES DANIEL (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DANIEL
Last Name:STOVER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:D
Other - Last Name:STOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1131 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3461
Mailing Address - Country:US
Mailing Address - Phone:919-774-6610
Mailing Address - Fax:919-774-3561
Practice Address - Street 1:1131 SPRING LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3461
Practice Address - Country:US
Practice Address - Phone:919-774-6610
Practice Address - Fax:919-774-3561
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist