Healthcare Provider Details

I. General information

NPI: 1720101413
Provider Name (Legal Business Name): CHARLES HOWARD LIND RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 FELLSMERE RD. UNIT B
SEBASTIAN FL
32958
US

IV. Provider business mailing address

5151 N HIGHWAY A1A #111
FORT PIERCE FL
34949-8248
US

V. Phone/Fax

Practice location:
  • Phone: 772-388-4636
  • Fax:
Mailing address:
  • Phone: 718-290-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: