MEDICARE: MR. CHARLES PATRICK GELSO BS 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	RP032966L	PA

General Provider Information

NPI Number	:	1922078666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES PATRICK GELSO BS RPH

Provider Business Mailing Address
First Line	:	430A MOUNTAIN VIEW DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612
Country	:	US
Telephone Number	:	570-675-0435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704
Country	:	US
Telephone Number	:	570-574-7166
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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