Provider Demographics
NPI:1699263251
Name:LANTRIP, CHARLES DAVID
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:LANTRIP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-4846
Mailing Address - Country:US
Mailing Address - Phone:325-660-0060
Mailing Address - Fax:
Practice Address - Street 1:300 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1824
Practice Address - Country:US
Practice Address - Phone:325-510-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist