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General NPI Number Information
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NPI Number | 1710666854
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Entity Type | Organization
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Legal Business Name | CHAFFEE PHARMACY INC.
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 6210 MASSARD RD STE 104
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City | FORT SMITH
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State | AR
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Zip | 72916-5042
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Country | US
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Telephone | 479-551-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 6210 MASSARD RD STE 104
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City | FORT SMITH
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State | AR
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Zip | 72916-5042
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Country | US
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Telephone | 479-551-2840
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Fax | 479-551-2492
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | DR. DANIELLE DDEDMON
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Credential | PHARM.D.
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Telephone | 479-551-2840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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