MEDICARE: AMANDA C CHASE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P2201X	Ambulatory Care Pharmacist	03236948	OH

General Provider Information

NPI Number	:	1245833763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA C CHASE PHARMD

Provider Business Mailing Address
First Line	:	1761 RUSTICWOOD LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-2457
Country	:	US
Telephone Number	:	216-970-5469
Fax Number	:

Provider Business Practice Location Address
First Line	:	3086 MADISON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-1723
Country	:	US
Telephone Number	:	513-321-9980
Fax Number	:	513-321-0582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	08/08/2021

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