Healthcare Provider Details

I. General information

NPI: 1487712238
Provider Name (Legal Business Name): SANDRA LEE CHASE BS, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WEALTHY ST SE MC 416
GRAND RAPIDS MI
49506-2921
US

IV. Provider business mailing address

7889 ASPENWOOD DR SE
ADA MI
49301-9613
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-5264
  • Fax: 616-774-7256
Mailing address:
  • Phone: 616-682-0514
  • Fax: 616-774-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025353
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: