Provider Demographics
NPI:1356782767
Name:NELSON, CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 47TH STREET CIR E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-8510
Mailing Address - Country:US
Mailing Address - Phone:941-722-9478
Mailing Address - Fax:
Practice Address - Street 1:8207 47TH STREET CIR E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-8510
Practice Address - Country:US
Practice Address - Phone:941-722-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 207941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist