Healthcare Provider Details

I. General information

NPI: 1952034894
Provider Name (Legal Business Name): CHASE ANGLIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 US HIGHWAY 90
GRAND BAY AL
36541-5609
US

IV. Provider business mailing address

1773 POPPS FERRY RD APT G37
BILOXI MS
39532-2273
US

V. Phone/Fax

Practice location:
  • Phone: 251-865-1429
  • Fax:
Mailing address:
  • Phone: 601-270-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number22559
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: