Provider Demographics
NPI:1013009380
Name:CHARLES F SHUSTER
Entity Type:Organization
Organization Name:CHARLES F SHUSTER
Other - Org Name:SPRINGDALE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:SHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-751-7408
Mailing Address - Street 1:400 W EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4471
Mailing Address - Country:US
Mailing Address - Phone:479-751-7408
Mailing Address - Fax:479-751-0304
Practice Address - Street 1:400 W EMMA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4471
Practice Address - Country:US
Practice Address - Phone:479-751-7408
Practice Address - Fax:479-751-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR10299333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100432407Medicaid