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General NPI Number Information
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NPI Number | 1487505913
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Entity Type | Individual
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Provider Name | CHARLES NELSON
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Gender | Male
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 4207 GALLIA ST
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City | NEW BOSTON
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State | OH
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Zip | 45662-5512
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Country | US
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Telephone | 740-456-4158
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Fax |
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Provider Business Mailing Address
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Address Line | 7751 STATE ROUTE 522
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City | PEDRO
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State | OH
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Zip | 45659-8959
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Country | US
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Telephone |
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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 | 03446340
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License Number State | OH
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