Provider Demographics
NPI:1568852309
Name:CHABALLA, KATE ALAINE (CPHT)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:ALAINE
Last Name:CHABALLA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1301
Mailing Address - Country:US
Mailing Address - Phone:732-706-5321
Mailing Address - Fax:732-865-9147
Practice Address - Street 1:2105 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1301
Practice Address - Country:US
Practice Address - Phone:732-706-5321
Practice Address - Fax:732-865-9147
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW00368500183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician