Provider Demographics
NPI:1295858306
Name:CHETLAN, ROBERT L (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:CHETLAN
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 1:25817 N SINGBUSH LOOP
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-1606
Mailing Address - Country:US
Mailing Address - Phone:623-516-9747
Mailing Address - Fax:
Practice Address - Street 1:9501 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6719
Practice Address - Country:US
Practice Address - Phone:180-096-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist