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General NPI Number Information
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NPI Number | 1679035323
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Entity Type | Individual
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Provider Name | CHASE AUSTIN BOARD PHARMD, CDCES
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 2480 LLEWELLYN AVE
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City | FORT GEORGE G MEADE
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State | MD
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Zip | 20755-7081
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Country | US
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Telephone | 410-278-5475
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Fax |
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Provider Business Mailing Address
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Address Line | 2480 LLEWELLYN AVE
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City | FORT GEORGE G MEADE
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State | MD
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Zip | 20755-7081
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Country | US
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Telephone |
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | PCT.0015418
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 0202218298
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License Number State | VA
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