Healthcare Provider Details

I. General information

NPI: 1699399626
Provider Name (Legal Business Name): CHARLES ALEXANDER OHR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PARK AVE
HUNTINGTON NY
11743-2799
US

IV. Provider business mailing address

270 PARK AVE
HUNTINGTON NY
11743-2799
US

V. Phone/Fax

Practice location:
  • Phone: 631-351-2272
  • Fax: 631-351-2048
Mailing address:
  • Phone: 631-351-2272
  • Fax: 631-351-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: