=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568852309
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATE ALAINE CHABALLA CPHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2015
-----------------------------------------------------
Last Update Date | 02/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2105 HIGHWAY 35
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07748-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-706-5321
-----------------------------------------------------
Fax | 732-865-9147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2105 HIGHWAY 35
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07748-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-706-5321
-----------------------------------------------------
Fax | 732-865-9147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 28RW00368500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------