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General NPI Number Information
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NPI Number | 1992391338
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Entity Type | Individual
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Provider Name | CHARLES R BOOTH
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Gender | Male
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Dates
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Enumeration Date | 12/20/2020
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Last Update Date | 12/20/2020
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Provider Practice Location Address
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Address Line | 4935 S ARLINGTON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-3516
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Country | US
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Telephone | 317-791-3822
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Fax |
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Provider Business Mailing Address
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Address Line | 3203 S LEONARD RD
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City | NEW PALESTINE
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State | IN
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Zip | 46163-9705
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Country | US
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Telephone | 317-861-5045
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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 | 26013981A
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License Number State | IN
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