Provider Demographics
NPI:1811017023
Name:STOVER, CHARLES E, SR
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E,
Last Name:STOVER
Suffix:SR
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 1:7519 FOREST EDGE LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7515
Mailing Address - Country:US
Mailing Address - Phone:334-272-1984
Mailing Address - Fax:
Practice Address - Street 1:5841 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2109
Practice Address - Country:US
Practice Address - Phone:334-277-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist