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General NPI Number Information
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NPI Number | 1851485148
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Entity Type | Organization
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Legal Business Name | CHIEF SUPER MARKET INC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 705 DEATRICK ST
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City | DEFIANCE
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State | OH
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Zip | 43512-2785
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Country | US
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Telephone | 419-784-0088
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Fax | 419-784-2273
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Provider Business Mailing Address
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Address Line | 1340 W HIGH ST STE E
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City | DEFIANCE
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State | OH
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Zip | 43512-5302
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Country | US
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Telephone | 419-784-0088
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Fax | 419-784-2273
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | THERESA STAFFORD
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Credential |
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Telephone | 419-782-0950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021695800
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License Number State | OH
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