Provider Demographics
NPI:1659483568
Name:CHANEY FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:CHANEY FAMILY PHARMACY LLC
Other - Org Name:PERKIN'S APOTHECARY AND MERCANTILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-242-0345
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-1267
Mailing Address - Country:US
Mailing Address - Phone:325-728-3484
Mailing Address - Fax:325-728-3467
Practice Address - Street 1:501 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-6223
Practice Address - Country:US
Practice Address - Phone:325-728-3484
Practice Address - Fax:325-728-3467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294683336C0003X
TX120783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146323OtherPK
4516083OtherNCPDP PROVIDER IDENTIFICATION NUMBER