Healthcare Provider Details

I. General information

NPI: 1437859766
Provider Name (Legal Business Name): CHEYENNE N PLAISTED CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24892 JOHN J WILLIAMS HWY
MILLSBORO DE
19966-4939
US

IV. Provider business mailing address

25945 HOLLY ST
MILLSBORO DE
19966-6571
US

V. Phone/Fax

Practice location:
  • Phone: 302-947-1204
  • Fax: 302-947-9402
Mailing address:
  • Phone: 302-612-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30225174
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: