Provider Demographics
NPI:1144621939
Name:MCMINN, CHAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:MCMINN
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 1:1817 N DOBSON RD APT 2109
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8721
Mailing Address - Country:US
Mailing Address - Phone:480-855-6895
Mailing Address - Fax:
Practice Address - Street 1:8826 N 23RD AVE # C2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4154
Practice Address - Country:US
Practice Address - Phone:602-216-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019494183500000X
COPHA0019542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist