Healthcare Provider Details

I. General information

NPI: 1205153335
Provider Name (Legal Business Name): CHARLES THOMAS MCHERRON RPH CIP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 ISLAND AVE
PHILADELPHIA PA
19153-1417
US

IV. Provider business mailing address

2512 ISLAND AVE
PHILADELPHIA PA
19153-1417
US

V. Phone/Fax

Practice location:
  • Phone: 215-937-9665
  • Fax: 215-365-2540
Mailing address:
  • Phone: 215-937-9665
  • Fax: 215-365-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030729L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: