Provider Demographics
NPI:1356836522
Name:CHANDLER, KEVIN JON (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JON
Last Name:CHANDLER
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 1:1028 RICHMOND AVE OFC
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4904
Mailing Address - Country:US
Mailing Address - Phone:479-310-6869
Mailing Address - Fax:
Practice Address - Street 1:1028 RICHMOND AVE OFC
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4904
Practice Address - Country:US
Practice Address - Phone:479-310-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041370L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist