Provider Demographics
NPI:1013238328
Name:MASSEY, CHARLES A, (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A,
Last Name:MASSEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1701 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-2415
Mailing Address - Country:US
Mailing Address - Phone:304-346-0829
Mailing Address - Fax:304-344-0563
Practice Address - Street 1:1701 4TH AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-2415
Practice Address - Country:US
Practice Address - Phone:304-346-0829
Practice Address - Fax:304-344-0563
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6501183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist