MEDICARE: CHESTERFIELD PHARMACY MEDICAL EQUIPMENT SUPPLIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053528976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTERFIELD PHARMACY MEDICAL EQUIPMENT SUPPLIES INC

Provider Business Mailing Address
First Line	:	720 7TH AVENUE
Second Line	:	STE 100
City	:	SEATTLE
State	:	WA
Zip	:	98104-1957
Country	:	US
Telephone Number	:	206-838-6070
Fax Number	:	206-838-9775

Provider Business Practice Location Address
First Line	:	720 7TH AVE
Second Line	:	STE 100
City	:	SEATTLE
State	:	WA
Zip	:	98104-1957
Country	:	US
Telephone Number	:	206-838-6070
Fax Number	:	206-838-9775

Authorized Official
Title or Position	:	CEO
Name	:	STELLA OGIALE
Credential	:
Telephone Number	:	206-838-6051

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	12/17/2012

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