Provider Demographics
NPI:1912309436
Name:SHEARCRAFT, CHARLES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:SHEARCRAFT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2335
Mailing Address - Country:US
Mailing Address - Phone:908-612-4041
Mailing Address - Fax:
Practice Address - Street 1:73 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1831
Practice Address - Country:US
Practice Address - Phone:973-817-9700
Practice Address - Fax:973-817-9701
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03499100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist