Healthcare Provider Details

I. General information

NPI: 1487400677
Provider Name (Legal Business Name): CHADWICK CABANERO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HIGHWAY 80 E
CLINTON MS
39056-4716
US

IV. Provider business mailing address

866 CYPRESS POND DR
COLLIERVILLE TN
38017-2165
US

V. Phone/Fax

Practice location:
  • Phone: 601-926-1179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberE-101454
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: