Provider Demographics
NPI:1508469370
Name:PATTERSON, CHAD EVAN
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EVAN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3418
Mailing Address - Country:US
Mailing Address - Phone:256-845-2004
Mailing Address - Fax:256-845-7839
Practice Address - Street 1:1916 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3418
Practice Address - Country:US
Practice Address - Phone:256-845-2004
Practice Address - Fax:256-845-7839
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist