MEDICARE: MRS. JILL CHARLES

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	26016873A	IN

General Provider Information

NPI Number	:	1811353626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL CHARLES

Provider Business Mailing Address
First Line	:	106 S COLUMBIA ST
Second Line	:
City	:	UNION CITY
State	:	IN
Zip	:	47390-1434
Country	:	US
Telephone Number	:	765-964-6000
Fax Number	:	765-964-6017

Provider Business Practice Location Address
First Line	:	106 S COLUMBIA ST
Second Line	:
City	:	UNION CITY
State	:	IN
Zip	:	47390-1434
Country	:	US
Telephone Number	:	765-964-6000
Fax Number	:	765-964-6017

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

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	01/08/2016

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Directions to “ MRS. JILL CHARLES ” Practice Location

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