Provider Demographics
NPI:1255493656
Name:CHANCE, GAYLE EILEEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:EILEEN
Last Name:CHANCE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 N BRYCE RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86413-9215
Mailing Address - Country:US
Mailing Address - Phone:928-565-2789
Mailing Address - Fax:
Practice Address - Street 1:2360 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7303
Practice Address - Country:US
Practice Address - Phone:928-763-5858
Practice Address - Fax:928-763-0972
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS14092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist