Provider Demographics
NPI:1558933242
Name:CHAMBERLAIN, EVERETT CHAD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:CHAD
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-1444
Mailing Address - Country:US
Mailing Address - Phone:908-475-1406
Mailing Address - Fax:
Practice Address - Street 1:10 MARKET ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1444
Practice Address - Country:US
Practice Address - Phone:908-475-1406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441506183500000X
FLPS32049183500000X
NJ28RI02340900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist