Healthcare Provider Details

I. General information

NPI: 1114655735
Provider Name (Legal Business Name): CHAE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 S LIMESTONE ST
SPRINGFIELD OH
45505-4015
US

IV. Provider business mailing address

1805 S LIMESTONE ST
SPRINGFIELD OH
45505-4015
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-5536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberUK164139
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: