Provider Demographics
NPI:1467085472
Name:WHITEFIELD, CHAD (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:WHITEFIELD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:CHAD
Other - Middle Name:ALAN
Other - Last Name:WHITEFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:591 HENRIETTA ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1452
Mailing Address - Country:US
Mailing Address - Phone:248-860-8664
Mailing Address - Fax:
Practice Address - Street 1:6054 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-1502
Practice Address - Country:US
Practice Address - Phone:877-531-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist