Individual
MR. CARL VICTOR CHALSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1791 HIGHWAY 64 E, ANAMOSA, IA 52205-2112
(319) 462-3306
(319) 462-6065
Mailing address
1791 HIGHWAY 64 E, ANAMOSA, IA 52205-2112
(319) 462-3306
(319) 462-6065
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
C16897
IA
1835P2201X
Ambulatory Care Pharmacist
16897
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C16897
STATE LICENSE NUMBER
IA
Enumeration date
02/22/2007
Last updated
06/16/2018
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