Provider Demographics
NPI:1124365713
Name:EMMETT, CHAD COLLINS (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:COLLINS
Last Name:EMMETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-1806
Mailing Address - Country:US
Mailing Address - Phone:801-963-7600
Mailing Address - Fax:
Practice Address - Street 1:109 E 8TH ST
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-1806
Practice Address - Country:US
Practice Address - Phone:801-963-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5826884-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist