=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326140773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAPMAN PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 05/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1396 N DICKINSON DR
-----------------------------------------------------
City | RUSK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75785-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-683-2422
-----------------------------------------------------
Fax | 903-683-2235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1396 N DICKINSON DR
-----------------------------------------------------
City | RUSK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75785-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-683-2422
-----------------------------------------------------
Fax | 903-683-2235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MONTE JAMES ETHINGTON
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 903-683-2422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 04510
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------