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General NPI Number Information
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NPI Number | 1053696757
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Entity Type | Individual
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Provider Name | MR. CHARLES WILLIAM PEARSON
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Gender | Male
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 441 N KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-3911
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Country | US
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Telephone | 314-965-7944
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Fax | 314-909-7121
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Provider Business Mailing Address
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Address Line | 1106 BARKWOOD TRAIL CT
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City | FENTON
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State | MO
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Zip | 63026-3794
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Country | US
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Telephone | 314-600-1534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 041510
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License Number State | MO
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