Provider Demographics
NPI:1457797334
Name:SIMPSON, CHARLES MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2680 REYNOLDS RANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6848
Mailing Address - Country:US
Mailing Address - Phone:209-366-7301
Mailing Address - Fax:
Practice Address - Street 1:2680 REYNOLDS RANCH PKWY
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6848
Practice Address - Country:US
Practice Address - Phone:209-366-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist