Provider Demographics
NPI:1568669414
Name:CHANCE, AENEAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:AENEAS
Middle Name:
Last Name:CHANCE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-1390
Mailing Address - Country:US
Mailing Address - Phone:530-346-1004
Mailing Address - Fax:530-346-1006
Practice Address - Street 1:9 DEPOT ST UNIT 5
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-1390
Practice Address - Country:US
Practice Address - Phone:530-346-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483801835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57143OtherSTATE BOARD OF PHARMACY