Charles Paul Petalas, R.PH.
Individual provider Active NPI Pharmacist · Ctr Barnstead, NH
NPI 1306065065 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1306065065
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- R0497 (NH)
- Practice address
- 136 S Shore Dr
Ctr Barnstead, NH 03225-3213 - Phone
- (603) 776-5707
- Fax
- (603) 776-0213
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- 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 |
|---|---|---|---|
| R0497 | NH | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | R0497 | NH | Yes |
Addresses
Primary practice location
136 S Shore Dr
Ctr Barnstead, NH 03225-3213
Mailing address
136 S Shore Dr
Ctr Barnstead, NH 03225-3213
Phone (603) 776-5707
Other providers in Ctr Barnstead, NH
All providers in Ctr Barnstead, NH · Pharmacist in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.