=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831526144
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES SCHINK RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2013
-----------------------------------------------------
Last Update Date | 10/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1212 OLD WILLOW LN
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-552-1525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1212 OLD WILLOW LN
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 9380
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 30031
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 6793
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------