Provider Demographics
NPI:1053514760
Name:KAISER, CHARLES PATRICK (PHARMD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PATRICK
Last Name:KAISER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10371 REDICK AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-3012
Mailing Address - Country:US
Mailing Address - Phone:402-669-1335
Mailing Address - Fax:402-592-2501
Practice Address - Street 1:11134 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3609
Practice Address - Country:US
Practice Address - Phone:402-592-5244
Practice Address - Fax:402-592-2501
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist