Healthcare Provider Details

I. General information

NPI: 1790642288
Provider Name (Legal Business Name): CHARLES DEWAYNE CHAINEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E PRIMROSE ST
SPRINGFIELD MO
65804-7929
US

IV. Provider business mailing address

4686 S FARM ROAD 199
ROGERSVILLE MO
65742-8696
US

V. Phone/Fax

Practice location:
  • Phone: 417-885-4719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number2000153193
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: