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General NPI Number Information
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NPI Number | 1790462281
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Entity Type | Individual
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Provider Name | CHARLESWORTH RAE RPH
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Gender | Male
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 20 BUFORD RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5202
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Country | US
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Telephone | 804-320-9740
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Fax | 804-320-9756
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Provider Business Mailing Address
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Address Line | 2819 HILLIARD RD APT H
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City | HENRICO
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State | VA
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Zip | 23228-4464
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Country | US
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Telephone | 571-218-0194
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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 | 0202210394
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License Number State | VA
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