Provider Demographics
NPI:1649634171
Name:BUONCRISTIANO, CHARLES GERARD (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:GERARD
Last Name:BUONCRISTIANO
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 1:9 PREBBLE LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5700
Mailing Address - Country:US
Mailing Address - Phone:207-641-7706
Mailing Address - Fax:
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-351-2150
Practice Address - Fax:207-351-3434
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR2874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist