MEDICARE: CHR-ASH INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054008703	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1451563	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1811081227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHR-ASH INC

Provider Business Mailing Address
First Line	:	1529 JOHNSON RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-3831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1529 JOHNSON RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-3831
Country	:	US
Telephone Number	:	618-451-4200
Fax Number	:	618-451-4252

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	STEPHEN BURDGE
Credential	:	RPH
Telephone Number	:	618-451-4200

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/07/2023

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Directions to “CHR-ASH INC ” Practice Location

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