Provider Demographics
NPI:1205835766
Name:CHASE, PHIL H (RPH, CDE, CDM)
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:H
Last Name:CHASE
Suffix:
Gender:M
Credentials:RPH, CDE, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30718 5TH PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4012
Mailing Address - Country:US
Mailing Address - Phone:253-839-4730
Mailing Address - Fax:253-839-4730
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-7213
Practice Address - Country:US
Practice Address - Phone:253-756-2521
Practice Address - Fax:253-756-2707
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00013605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist