Provider Demographics
NPI:1467764910
Name:CHACE, PAUL B (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:B
Last Name:CHACE
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 1:290 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3684
Mailing Address - Country:US
Mailing Address - Phone:207-210-1498
Mailing Address - Fax:207-774-7729
Practice Address - Street 1:290 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3684
Practice Address - Country:US
Practice Address - Phone:207-210-1498
Practice Address - Fax:207-774-7729
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist