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NPI Code Detail

MEDICARE: DR. CHARLES MICHAEL PATRICK JR. PHARMD

MEDICARE: DR. CHARLES MICHAEL PATRICK JR. PHARMD
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
1183500000XPharmacist012579KY

General Provider Information

NPI Number : 1801426986
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES MICHAEL PATRICK JR. PHARMD
Provider Business Mailing Address
First Line : 478 KY 11 N
Second Line :
City : BOONEVILLE
State : KY
Zip : 41314-9155
Country : US
Telephone Number : 606-560-9181
Fax Number :
Provider Business Practice Location Address
First Line : 478 KY 11 N
Second Line :
City : BOONEVILLE
State : KY
Zip : 41314-9155
Country : US
Telephone Number : 606-560-9181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2020
Last Update Date : 01/17/2020

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