Provider Demographics
NPI:1316061211
Name:PELHAM, CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:PELHAM
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 1:1728 BALTZER RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-9339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 WATER ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:AL
Practice Address - Zip Code:36786
Practice Address - Country:US
Practice Address - Phone:334-628-2241
Practice Address - Fax:334-628-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist