Individual provider Active NPI

David Charlestham, PHARMD

  • Psychiatric Pharmacist
  • Fresno, CA
National Provider Identifier
1558783514
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric PharmacistTaxonomy code 1835P1300X
License
78307 Issued in CA
Practice address
2615 E Clinton Ave
(119)
Fresno, CA 93703-2223
Phone
(559) 225-6100
Fax
(559) 241-6496
NPI assigned
Jan 10, 2014
Last updated
Mar 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 78307 CA
Pharmacist 183500000X 0202212256 VA
Psychiatric Pharmacist 1835P1300X 0202212256 VA
Psychiatric Pharmacist 1835P1300X 78307 CA Primary

Addresses

Primary practice location

2615 E Clinton Ave
(119)
Fresno, CA 93703-2223

Mailing address

2615 E Clinton Ave
(119)
Fresno, CA 93703-2223
Phone (559) 225-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
0202212256VAMDPsychiatric Pharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1558783514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 E CLINTON AVE",
            "address_2": "(119)",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937032223",
            "telephone_number": "559-225-6100",
            "fax_number": "559-241-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 E CLINTON AVE",
            "address_2": "(119)",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937032223",
            "telephone_number": "559-225-6100",
            "fax_number": "559-241-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLESTHAM",
        "first_name": "DAVID",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-10",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "78307",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202212256",
            "primary": false
        },
        {
            "code": "1835P1300X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Psychiatric",
            "state": "VA",
            "license": "0202212256",
            "primary": false
        },
        {
            "code": "1835P1300X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Psychiatric",
            "state": "CA",
            "license": "78307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.