Healthcare Provider Details

I. General information

NPI: 1154386787
Provider Name (Legal Business Name): CHARLES T. GEORGE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N CAROLYN DR
MINONK IL
61760-9326
US

IV. Provider business mailing address

25 BROOK VIEW DR
LA SALLE IL
61301-9669
US

V. Phone/Fax

Practice location:
  • Phone: 309-432-3451
  • Fax:
Mailing address:
  • Phone: 815-343-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-037663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: