MEDICARE: CHAS SOUTHGATE PHARMACY

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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912549254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAS SOUTHGATE PHARMACY

Provider Business Mailing Address
First Line	:	731 N IRON BRIDGE WAY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-4926
Country	:	US
Telephone Number	:	509-444-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	5620 S REGAL ST STE 11
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-7957
Country	:	US
Telephone Number	:	509-444-8888
Fax Number	:	509-448-0907

Authorized Official
Title or Position	:	CEO
Name	:	AARON WILSON
Credential	:
Telephone Number	:	509-444-8888

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	01/05/2026

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Directions to “CHAS SOUTHGATE PHARMACY ” Practice Location

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