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NPI Code Detail

MEDICARE: CHARLES WILLIAM CHAVERIAT RPH

MEDICARE: CHARLES WILLIAM CHAVERIAT 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
1183500000XPharmacist9875-040WI

General Provider Information

NPI Number : 1447536560
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES WILLIAM CHAVERIAT RPH
Provider Business Mailing Address
First Line : 4500 N BROOKFIELD RD
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-1023
Country : US
Telephone Number : 262-783-6186
Fax Number :
Provider Business Practice Location Address
First Line : 10800 W CAPITOL DR
Second Line :
City : WAUWATOSA
State : WI
Zip : 53222-1109
Country : US
Telephone Number : 414-466-1221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2011
Last Update Date : 11/02/2011

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