MEDICARE: MR. CHARLES EDWIN BIANCHI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6897	KY

General Provider Information

NPI Number	:	1215920517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES EDWIN BIANCHI RPH

Provider Business Mailing Address
First Line	:	117 TRADEPARK DR
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-3428
Country	:	US
Telephone Number	:	606-679-5614
Fax Number	:	606-679-6964

Provider Business Practice Location Address
First Line	:	117 TRADEPARK DR
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-3428
Country	:	US
Telephone Number	:	606-679-5614
Fax Number	:	606-679-6964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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