Provider Demographics
NPI:1215478813
Name:RABUCK, CHARLES D III (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:RABUCK
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12557 RAVENWOOD DR
Mailing Address - Street 2:STE. 112
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9009
Mailing Address - Country:US
Mailing Address - Phone:440-226-3380
Mailing Address - Fax:440-214-7017
Practice Address - Street 1:12557 RAVENWOOD DR
Practice Address - Street 2:STE. 112
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9009
Practice Address - Country:US
Practice Address - Phone:440-226-3380
Practice Address - Fax:440-214-7017
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-23727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist