Provider Demographics
NPI:1316076862
Name:OLIVER, CHARLES ROBERT (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROBERT
Last Name:OLIVER
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 1:742 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2754
Mailing Address - Country:US
Mailing Address - Phone:270-651-5133
Mailing Address - Fax:270-651-6198
Practice Address - Street 1:742 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2754
Practice Address - Country:US
Practice Address - Phone:270-651-5133
Practice Address - Fax:270-651-6198
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist