Provider Demographics
NPI:1235270109
Name:CHASTAIN, TINA STONE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:STONE
Last Name:CHASTAIN
Suffix:
Gender:F
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 1082
Mailing Address - Street 2:
Mailing Address - City:JOHNSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29555-1082
Mailing Address - Country:US
Mailing Address - Phone:843-386-9518
Mailing Address - Fax:843-493-3005
Practice Address - Street 1:616 SOUTH WALNUT STREET
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583-0637
Practice Address - Country:US
Practice Address - Phone:843-493-2311
Practice Address - Fax:843-493-3005
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC08970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist