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General NPI Number Information
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NPI Number | 1376762724
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Entity Type | Individual
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Provider Name | CHARLES DONOVAN REDFEARN RPH
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2400 S AVENUE A
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City | YUMA
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State | AZ
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Zip | 85364-7127
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Country | US
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Telephone | 928-336-7819
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Fax | 928-336-7696
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Provider Business Mailing Address
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Address Line | 4674 W 27TH PL
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City | YUMA
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State | AZ
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Zip | 85364-7554
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Country | US
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Telephone | 928-341-4520
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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 | 12337
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License Number State | AZ
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