Provider Demographics
NPI:1326643743
Name:IM, CHLOE ZADETH (RPH)
Entity Type:Individual
Prefix:MISS
First Name:CHLOE ZADETH
Middle Name:
Last Name:IM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:ZADETH
Other - Middle Name:
Other - Last Name:IM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:250 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-3000
Mailing Address - Country:US
Mailing Address - Phone:508-996-0807
Mailing Address - Fax:508-966-2711
Practice Address - Street 1:250 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-3000
Practice Address - Country:US
Practice Address - Phone:508-966-0807
Practice Address - Fax:508-966-2711
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist