Healthcare Provider Details

I. General information

NPI: 1306197843
Provider Name (Legal Business Name): CHARLES EUGENE LEBEGERN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 GENERAL KNOX RD
WASHINGTON CROSSING PA
18977-1359
US

IV. Provider business mailing address

1091 GENERAL KNOX RD PO BOX 742
WASHINGTON CROSSING PA
18977-1359
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-7670
  • Fax: 215-321-7640
Mailing address:
  • Phone: 215-321-7670
  • Fax: 215-321-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP415365L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: