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General NPI Number Information
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NPI Number | 1255476834
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Entity Type | Individual
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Provider Name | CHARLES SCOTT JUSTUS RPH
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 305 OLD KENTUCKY TPK
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City | CEDAR BLUFF
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State | VA
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Zip | 24609
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Country | US
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Telephone | 276-964-0555
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Fax | 276-964-2999
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Provider Business Mailing Address
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Address Line | 148 OAK HILL LN
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City | ROSEDALE
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State | VA
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Zip | 24280-3591
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Country | US
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Telephone | 276-880-2112
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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 | 0202012132
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License Number State | VA
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