Provider Demographics
NPI:1578216420
Name:ROY, CHANTEL A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:A
Last Name:ROY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CHANTEL
Other - Middle Name:A
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:18911 S TAMIAMI TRL STE 13
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4739
Mailing Address - Country:US
Mailing Address - Phone:239-590-8820
Mailing Address - Fax:
Practice Address - Street 1:18911 S TAMIAMI TRL STE 13
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4739
Practice Address - Country:US
Practice Address - Phone:239-590-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist