Provider Demographics
NPI:1982712550
Name:MUDAY, CHARLES (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MUDAY
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 PIFER RD
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-8558
Mailing Address - Country:US
Mailing Address - Phone:269-623-2649
Mailing Address - Fax:
Practice Address - Street 1:127 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1830
Practice Address - Country:US
Practice Address - Phone:269-945-2333
Practice Address - Fax:269-945-2991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist