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General NPI Number Information
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NPI Number | 1487712238
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Entity Type | Individual
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Provider Name | SANDRA LEE CHASE BS, PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1840 WEALTHY ST SE MC 416
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2921
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Country | US
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Telephone | 616-774-5264
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Fax | 616-774-7256
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Provider Business Mailing Address
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Address Line | 7889 ASPENWOOD DR SE
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City | ADA
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State | MI
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Zip | 49301-9613
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Country | US
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Telephone | 616-682-0514
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Fax | 616-774-7256
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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 | 5302025353
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License Number State | MI
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