Provider Demographics
NPI:1891075750
Name:DE LA TORRE, CHARLES RAFAEL (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAFAEL
Last Name:DE LA TORRE
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 1:1937 GLEN LAKES CIR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2145
Mailing Address - Country:US
Mailing Address - Phone:727-348-1301
Mailing Address - Fax:
Practice Address - Street 1:17757 US HIGHWAY 19 N # 5E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6560
Practice Address - Country:US
Practice Address - Phone:727-467-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist