Healthcare Provider Details

I. General information

NPI: 1043324031
Provider Name (Legal Business Name): CHARLES H STANTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S US HIGHWAY 287
ELKHART TX
75839-6726
US

IV. Provider business mailing address

306 S US HIGHWAY 287
ELKHART TX
75839-6726
US

V. Phone/Fax

Practice location:
  • Phone: 903-764-2355
  • Fax: 903-764-2418
Mailing address:
  • Phone: 903-764-2355
  • Fax: 903-764-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13804
License Number StateTX

VIII. Authorized Official

Name: CHARLES STANTON
Title or Position: OWNER
Credential: RPH
Phone: 903-764-2355