Healthcare Provider Details

I. General information

NPI: 1841291499
Provider Name (Legal Business Name): CHESAPEAKE INFUSION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 BUSINESS CENTER DR SUITE 1 BUILDING C
MEMPHIS TN
38134-5628
US

IV. Provider business mailing address

6272 LEE VISTA BLVD LEGAL DEPT
ORLANDO FL
32822-5148
US

V. Phone/Fax

Practice location:
  • Phone: 800-260-6667
  • Fax:
Mailing address:
  • Phone: 888-773-7376
  • Fax: 888-773-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3587
License Number StateTN

VIII. Authorized Official

Name: GAYLE JOHNSTON
Title or Position: VP OF OPERATIONS
Credential:
Phone: 407-854-6532