Healthcare Provider Details

I. General information

NPI: 1962730150
Provider Name (Legal Business Name): CHESTERFIELD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2009
Last Update Date: 11/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 COLUMBIA ST
SEATTLE WA
98104-1965
US

IV. Provider business mailing address

703 COLUMBIA ST
SEATTLE WA
98104-1965
US

V. Phone/Fax

Practice location:
  • Phone: 206-838-6050
  • Fax:
Mailing address:
  • Phone: 206-838-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNO PHAR.CF.00057419
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberNO PHAR.CF.00057419
License Number StateWA

VIII. Authorized Official

Name: STELLA OGIALE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 206-838-6050