MEDICARE: MR. CHARLES EDWARD ELMORE 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	5302019908	MI

General Provider Information

NPI Number	:	1669539920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES EDWARD ELMORE RPH

Provider Business Mailing Address
First Line	:	9366 NEWBURG CT
Second Line	:
City	:	TECUMSEH
State	:	MI
Zip	:	49286-9755
Country	:	US
Telephone Number	:	517-423-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 W CHICAGO BLVD
Second Line	:
City	:	TECUMSEH
State	:	MI
Zip	:	49286-8727
Country	:	US
Telephone Number	:	517-424-1212
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. CHARLES EDWARD ELMORE RPH” Practice Location

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