Provider Demographics
NPI:1205110145
Name:CHARTER, GARY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LYNN
Last Name:CHARTER
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 1:8903 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3804
Mailing Address - Country:US
Mailing Address - Phone:316-722-4281
Mailing Address - Fax:316-722-6171
Practice Address - Street 1:8903 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3804
Practice Address - Country:US
Practice Address - Phone:316-722-4281
Practice Address - Fax:316-722-6171
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-08995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist