Charles Allen Dutcher, R.PH.
Individual provider Active NPI Pharmacist · Taylor, AZ
NPI 1659396174 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1659396174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 6483 (AZ)
- Practice address
- 660 N. Main
Taylor, AZ 85939-0919 - Phone
- (928) 536-2044
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 6483 | AZ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 6483 | AZ | Yes |
Addresses
Primary practice location
660 N. Main
Taylor, AZ 85939-0919
Mailing address
660 N. Main
P.O. Box 919
Taylor, AZ 85939-0919
Phone (928) 536-2044
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122862 | Other | AZ | AHCCCS ID |
| 0319865 | Other | AZ | NCPDP |
Other providers in Taylor, AZ
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.