=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336126994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD CHARPENTIER JR. PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2005
-----------------------------------------------------
Last Update Date | 04/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2625 N KANSAS EXPY
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65803-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-869-9003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2625 N KANSAS EXPY
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65803-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-869-9003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 2001023387
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------