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General NPI Number Information
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NPI Number | 1700184397
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Entity Type | Individual
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Provider Name | KENNETH H. CHAFFIN RPH
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Gender | Male
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 11/11/2012
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Provider Practice Location Address
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Address Line | 645 RUSSELL RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3637
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Country | US
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Telephone | 770-682-5512
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Fax | 770-962-7626
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Provider Business Mailing Address
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Address Line | 645 RUSSELL RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3637
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Country | US
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Telephone | 770-682-5512
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Fax | 770-962-7626
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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 | 013628
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License Number State | GA
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