Provider Demographics
NPI:1568250934
Name:MCKISSON, CHARLES LAWTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LAWTON
Last Name:MCKISSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 HOPEWELL DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9372
Mailing Address - Country:US
Mailing Address - Phone:419-410-3755
Mailing Address - Fax:
Practice Address - Street 1:364 HOPEWELL DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9372
Practice Address - Country:US
Practice Address - Phone:419-410-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031320231835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy