Provider Demographics
NPI:1154386787
Name:GEORGE, CHARLES T (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:GEORGE
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 1:25 BROOK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-9669
Mailing Address - Country:US
Mailing Address - Phone:815-343-7060
Mailing Address - Fax:
Practice Address - Street 1:1305 N CAROLYN DR
Practice Address - Street 2:
Practice Address - City:MINONK
Practice Address - State:IL
Practice Address - Zip Code:61760-9326
Practice Address - Country:US
Practice Address - Phone:309-432-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-037663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist