MEDICARE: MR. CHARLES KEVIN EARLY RPH

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	5494	CT

General Provider Information

NPI Number	:	1366945040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES KEVIN EARLY RPH

Provider Business Mailing Address
First Line	:	21 JAY LN
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 JAY LN
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-2102
Country	:	US
Telephone Number	:	203-814-4421
Fax Number	:

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	03/09/2018

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