MEDICARE: MS. KATE ALAINE CHABALLA CPHT

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	183700000X	Pharmacy Technician	28RW00368500	NJ

General Provider Information

NPI Number	:	1568852309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATE ALAINE CHABALLA CPHT

Provider Business Mailing Address
First Line	:	2105 HIGHWAY 35
Second Line	:
City	:	MIDDLETOWN
State	:	NJ
Zip	:	07748-1301
Country	:	US
Telephone Number	:	732-706-5321
Fax Number	:	732-865-9147

Provider Business Practice Location Address
First Line	:	2105 HIGHWAY 35
Second Line	:
City	:	MIDDLETOWN
State	:	NJ
Zip	:	07748-1301
Country	:	US
Telephone Number	:	732-706-5321
Fax Number	:	732-865-9147

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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