Healthcare Provider Details

I. General information

NPI: 1457635302
Provider Name (Legal Business Name): CHARLES ALEXANDER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HERNDON AVE
CLOVIS CA
93611-6109
US

IV. Provider business mailing address

1815 HERNDON AVE
CLOVIS CA
93611-6109
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-1324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH63568
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS45478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: