Provider Demographics
NPI:1558648170
Name:ULLOM, CHAD (RPH)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ULLOM
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 1:1001 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-2100
Mailing Address - Country:US
Mailing Address - Phone:785-354-1470
Mailing Address - Fax:785-354-7782
Practice Address - Street 1:1001 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-2100
Practice Address - Country:US
Practice Address - Phone:785-354-1470
Practice Address - Fax:785-354-7782
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038098183500000X
KS1-12503183500000X
IL051.293421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist