Provider Demographics
NPI:1306061510
Name:LOUISELL, CHARLES DOUGLAS (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:LOUISELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 N SPRINKLE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-9621
Mailing Address - Country:US
Mailing Address - Phone:269-344-0109
Mailing Address - Fax:
Practice Address - Street 1:1950 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5334
Practice Address - Country:US
Practice Address - Phone:269-321-0664
Practice Address - Fax:269-324-9670
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist