=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811998461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESAPEAKE INFUSION INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 QUIGLEY BLVD
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19720-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-540-4755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6272 LEE VISTA BLVD LEGAL DEPT.
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32822-5148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-773-7376
-----------------------------------------------------
Fax | 888-773-7386
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | GAYLE JOHNSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-854-6532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | A3-0000703
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------