Mary Alice Charboneau, R.PH.
Individual provider Active NPI Pharmacist · Aptos, CA
NPI 1104280494 · NPPES record last updated Apr 12, 2016
Key facts
- NPI
- 1104280494
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP55349 (CA)
- Practice address
- 80 Ranch del Mar
Aptos, CA 95003 - Phone
- (831) 688-6417
- NPI assigned
- Apr 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP55349 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP55349 | CA | Yes |
Addresses
Primary practice location
80 Ranch del Mar
Aptos, CA 95003
Mailing address
164 Seaclif Dr
Aptos, CA 95003
Phone (707) 337-7219
Other providers in Aptos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.