=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376253781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. CHARLES ALVIN MEADOWS JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2022
-----------------------------------------------------
Last Update Date | 11/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21013 OLD SORTERS RD STE C
-----------------------------------------------------
City | PORTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77365-7083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-747-7445
-----------------------------------------------------
Fax | 281-605-5337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21013 OLD SORTERS RD STE C
-----------------------------------------------------
City | PORTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77365-7083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-747-7445
-----------------------------------------------------
Fax | 281-605-5337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 34529
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------