Provider Demographics
NPI:1881868198
Name:FRITZ, CHARLES J (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:FRITZ
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 1:494 W SIDE SQ
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1753
Mailing Address - Country:US
Mailing Address - Phone:217-854-4022
Mailing Address - Fax:217-854-4300
Practice Address - Street 1:494 W SIDE SQ
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1753
Practice Address - Country:US
Practice Address - Phone:217-854-4022
Practice Address - Fax:217-854-4300
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL261337649001Medicaid
IL0421680001Medicare UPIN