Healthcare Provider Details

I. General information

NPI: 1801182886
Provider Name (Legal Business Name): CHANTELLE HOLLIE MACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANTELLE HOLLIE YOUNG PHARM D

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8027 N CEDAR AVE
FRESNO CA
93720-4827
US

IV. Provider business mailing address

1608 N MCPHERSON LN
CLOVIS CA
93619-5123
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-1002
  • Fax:
Mailing address:
  • Phone: 760-216-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: