Provider Demographics
NPI:1548693864
Name:SCHLEY, CHARLES LEONARD (PH00009964)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEONARD
Last Name:SCHLEY
Suffix:
Gender:M
Credentials:PH00009964
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 212TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-7136
Mailing Address - Country:US
Mailing Address - Phone:206-450-5943
Mailing Address - Fax:
Practice Address - Street 1:5006 132ND ST SE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9517
Practice Address - Country:US
Practice Address - Phone:425-357-6162
Practice Address - Fax:425-357-6125
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6029144Medicaid