MEDICARE: ANDRE RAWLE CHARLES 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	066780	NY

General Provider Information

NPI Number	:	1497366447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE RAWLE CHARLES RPH

Provider Business Mailing Address
First Line	:	4111 PARSONS BLVD APT 205
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-1920
Country	:	US
Telephone Number	:	347-276-7037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 COMMERCE AVE FRNT 3
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-3612
Country	:	US
Telephone Number	:	347-612-8456
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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