Provider Demographics
NPI:1184222432
Name:TOUSSANT, CHAD (RPH)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:TOUSSANT
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:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-1625
Mailing Address - Country:US
Mailing Address - Phone:757-717-1703
Mailing Address - Fax:
Practice Address - Street 1:502 W MYRTLE ST APT 108
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-3613
Practice Address - Country:US
Practice Address - Phone:757-717-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist