Provider Demographics
NPI:1093319394
Name:FLEAHMAN, CHAD T (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:T
Last Name:FLEAHMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 BEMIDJI AVE N
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2318
Mailing Address - Country:US
Mailing Address - Phone:218-751-1626
Mailing Address - Fax:
Practice Address - Street 1:2312 BEMIDJI AVE N
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2318
Practice Address - Country:US
Practice Address - Phone:218-751-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122202OtherMINNESOTA LICCENST NUMBER