Healthcare Provider Details

I. General information

NPI: 1932378007
Provider Name (Legal Business Name): MICHAEL RALPH CHASE R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAIN RD W
HAZEN ND
58545
US

IV. Provider business mailing address

612 4TH ST NE
HAZEN ND
58545-4605
US

V. Phone/Fax

Practice location:
  • Phone: 701-748-2312
  • Fax: 701-748-2637
Mailing address:
  • Phone: 701-748-6281
  • Fax: 701-748-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number3470
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: