Healthcare Provider Details

I. General information

NPI: 1518512763
Provider Name (Legal Business Name): HANNAH MICHELLE CHITTENDEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

311 LANG CT
ENGLEWOOD OH
45322-3332
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3925
  • Fax:
Mailing address:
  • Phone: 330-749-7253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03439002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: