MEDICARE: AUDREY CHIPKA 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	5302040877	MI

General Provider Information

NPI Number	:	1912362229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY CHIPKA PHARM.D.

Provider Business Mailing Address
First Line	:	11550 DELMAR DR
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-8929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11550 DELMAR DR
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-8929
Country	:	US
Telephone Number	:	208-001-6561
Fax Number	:

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

Provider Enumeration Date	:	12/31/2015
Last Update Date	:	03/12/2026

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