Individual
MICAH CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1712 E OHIO ST, CLINTON, MO 64735-2402
(660) 890-2587
Mailing address
1712 E OHIO ST, CLINTON, MO 64735-2402
(660) 890-2587
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2009011780
MO
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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