MEDICARE: MR. CHARLES THOMAS MCHERRON RPH CIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP030729L	PA

General Provider Information

NPI Number	:	1205153335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES THOMAS MCHERRON RPH CIP

Provider Business Mailing Address
First Line	:	2512 ISLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1417
Country	:	US
Telephone Number	:	215-937-9665
Fax Number	:	215-365-2540

Provider Business Practice Location Address
First Line	:	2512 ISLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1417
Country	:	US
Telephone Number	:	215-937-9665
Fax Number	:	215-365-2540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	04/29/2010

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