MEDICARE: CHARLES H D'ARDENNE JR. 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	RP031135L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP031135L	OTHER	PA	STATE

General Provider Information

NPI Number	:	1407154230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES H D'ARDENNE JR. RPH

Provider Business Mailing Address
First Line	:	1244 ALEXANDER DR
Second Line	:
City	:	HATFIELD
State	:	PA
Zip	:	19440-3461
Country	:	US
Telephone Number	:	610-630-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 W MAIN ST
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-1611
Country	:	US
Telephone Number	:	610-630-0882
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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