Individual
CHANNING THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3331 PLEASANT VALLEY BLVD, ALTOONA, PA 16602-4311
(814) 942-1081
Mailing address
1001 HENCH CIR APT 5, ALTOONA, PA 16602-6919
(606) 253-1260
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP450963
PA
Other
Enumeration date
09/10/2016
Last updated
09/10/2016
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