Provider Demographics
NPI:1912005018
Name:DOBBS, CHARLES J (RPH, MBA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:DOBBS
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17632 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:436 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6523
Practice Address - Country:US
Practice Address - Phone:909-875-7260
Practice Address - Fax:909-875-7265
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist