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General NPI Number Information
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NPI Number | 1164057899
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Entity Type | Individual
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Provider Name | CHASE HOLBROOK
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Gender | Male
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 262 CORDELE RD
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City | ALBANY
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State | GA
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Zip | 31705-2407
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Country | US
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Telephone | 229-352-9459
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Fax |
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Provider Business Mailing Address
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Address Line | 499 HENRY RD
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City | SYLVESTER
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State | GA
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Zip | 31791-7961
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Country | US
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Telephone | 229-349-1992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 027240
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License Number State | GA
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