Healthcare Provider Details

I. General information

NPI: 1770137812
Provider Name (Legal Business Name): CHARLES VANA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 DIXIE HWY
CLARKSTON MI
48346-3422
US

IV. Provider business mailing address

125 MILL OAKS LN
HOLLY MI
48442-8102
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-6680
  • Fax:
Mailing address:
  • Phone: 248-245-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302411619
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: