Provider Demographics
NPI:1114055324
Name:CHASE PHARMACY
Entity Type:Organization
Organization Name:CHASE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-463-2242
Mailing Address - Street 1:21 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-0189
Mailing Address - Country:US
Mailing Address - Phone:701-463-2242
Mailing Address - Fax:701-463-2311
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-0189
Practice Address - Country:US
Practice Address - Phone:701-463-2242
Practice Address - Fax:701-463-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1553336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND020624Medicaid
ND020624Medicaid