MEDICARE: CHARLES NELSON

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	03446340	OH

General Provider Information

NPI Number	:	1487505913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES NELSON

Provider Business Mailing Address
First Line	:	7751 STATE ROUTE 522
Second Line	:
City	:	PEDRO
State	:	OH
Zip	:	45659-8959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 GALLIA ST
Second Line	:
City	:	NEW BOSTON
State	:	OH
Zip	:	45662-5512
Country	:	US
Telephone Number	:	740-456-4158
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ CHARLES NELSON ” Practice Location

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