Healthcare Provider Details

I. General information

NPI: 1740200963
Provider Name (Legal Business Name): JOHN WILLIAM CHARLES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W JESSIE ST
RUSHFORD MN
55971-8837
US

IV. Provider business mailing address

PO BOX 370
RUSHFORD MN
55971-0370
US

V. Phone/Fax

Practice location:
  • Phone: 507-864-2153
  • Fax:
Mailing address:
  • Phone: 507-864-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115910-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: