Provider Demographics
NPI:1801684121
Name:HART, CHARLES M III (PHARMD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:HART
Suffix:III
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17335 GOLF PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-0006
Mailing Address - Country:US
Mailing Address - Phone:262-432-5135
Mailing Address - Fax:
Practice Address - Street 1:17335 GOLF PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-0006
Practice Address - Country:US
Practice Address - Phone:262-432-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist