Provider Demographics
NPI:1801238027
Name:CHARETTE, CHANCELLOR THOMAS (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:CHANCELLOR
Middle Name:THOMAS
Last Name:CHARETTE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 G ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6833
Mailing Address - Country:US
Mailing Address - Phone:619-237-7660
Mailing Address - Fax:619-237-7670
Practice Address - Street 1:101 G ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6833
Practice Address - Country:US
Practice Address - Phone:619-237-7660
Practice Address - Fax:619-237-7670
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76369183500000X, 1835P0018X
OH03232555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist