Provider Demographics
NPI:1205153335
Name:MCHERRON, CHARLES THOMAS (RPH CIP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:THOMAS
Last Name:MCHERRON
Suffix:
Gender:M
Credentials:RPH CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1417
Mailing Address - Country:US
Mailing Address - Phone:215-937-9665
Mailing Address - Fax:215-365-2540
Practice Address - Street 1:2512 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-1417
Practice Address - Country:US
Practice Address - Phone:215-937-9665
Practice Address - Fax:215-365-2540
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030729L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist