Provider Demographics
NPI:1578887345
Name:CHAPMAN, DEREK (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:CHAPMAN
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 1:615 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1917
Mailing Address - Country:US
Mailing Address - Phone:404-761-1136
Mailing Address - Fax:404-761-1711
Practice Address - Street 1:615 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1917
Practice Address - Country:US
Practice Address - Phone:404-761-1136
Practice Address - Fax:404-761-1711
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist