Provider Demographics
NPI:1275662751
Name:GAGE, CHRIS A (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:A
Last Name:GAGE
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 1:703 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036
Mailing Address - Country:US
Mailing Address - Phone:515-432-8253
Mailing Address - Fax:
Practice Address - Street 1:310 STORY STR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036
Practice Address - Country:US
Practice Address - Phone:515-432-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG15016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG15016OtherIOWA PHARMACIST LICENSE
IAI3114Medicare ID - Type Unspecified