MEDICARE: CHAD MCMINN PHARMD

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	183500000X	Pharmacist	S019494	AZ
2	183500000X	Pharmacist	PHA0019542	CO

General Provider Information

NPI Number	:	1144621939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD MCMINN PHARMD

Provider Business Mailing Address
First Line	:	1817 N DOBSON RD APT 2109
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-8721
Country	:	US
Telephone Number	:	480-855-6895
Fax Number	:

Provider Business Practice Location Address
First Line	:	8826 N 23RD AVE # C2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4154
Country	:	US
Telephone Number	:	602-216-1189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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Directions to “ CHAD MCMINN PHARMD” Practice Location

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