Healthcare Provider Details

I. General information

NPI: 1174014575
Provider Name (Legal Business Name): CHARLES PEARLMUTTER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 MCCRACKEN RD STE A-UP
GARFIELD HEIGHTS OH
44125
US

IV. Provider business mailing address

3627 BERKELEY RD
CLEVELAND HEIGHTS OH
44118-1940
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-6727
  • Fax:
Mailing address:
  • Phone: 216-262-7959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03126045
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: