Provider Demographics
NPI:1184933749
Name:FENSKE, CHARLES R (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:FENSKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 N BICKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2505
Mailing Address - Country:US
Mailing Address - Phone:919-496-6111
Mailing Address - Fax:919-497-0540
Practice Address - Street 1:102 N BICKETT BLVD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2505
Practice Address - Country:US
Practice Address - Phone:919-496-6111
Practice Address - Fax:919-497-0540
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist