MEDICARE: GAYLE EILEEN CHANCE PHARM D

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	183500000X	Pharmacist	S14092	AZ

General Provider Information

NPI Number	:	1255493656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE EILEEN CHANCE PHARM D

Provider Business Mailing Address
First Line	:	3326 N BRYCE RD
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-9215
Country	:	US
Telephone Number	:	928-565-2789
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 HIGHWAY 95
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7303
Country	:	US
Telephone Number	:	928-763-5858
Fax Number	:	928-763-0972

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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