Provider Demographics
NPI:1548373442
Name:VRETIS, CHARLES BANCROFT (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BANCROFT
Last Name:VRETIS
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 1:1475 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:TX
Mailing Address - Zip Code:78962-3671
Mailing Address - Country:US
Mailing Address - Phone:979-732-5432
Mailing Address - Fax:
Practice Address - Street 1:1475 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:TX
Practice Address - Zip Code:78962-3671
Practice Address - Country:US
Practice Address - Phone:979-732-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist