MEDICARE: MR. CHARLES PATRICK STACHOWIAK RPH, CRPH

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	PS18157	FL

General Provider Information

NPI Number	:	1568641645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES PATRICK STACHOWIAK RPH, CRPH

Provider Business Mailing Address
First Line	:	12410 MONDRAGON DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-6560
Country	:	US
Telephone Number	:	813-484-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2626
Country	:	US
Telephone Number	:	813-877-9700
Fax Number	:	813-877-2300

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	07/24/2013

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