Provider Demographics
NPI:1679695084
Name:MENTELE, CHAD MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:MENTELE
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 1:6100 NW 97TH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2866
Mailing Address - Country:US
Mailing Address - Phone:515-986-5250
Mailing Address - Fax:
Practice Address - Street 1:3580 EP TRUE PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-7647
Practice Address - Country:US
Practice Address - Phone:515-267-8066
Practice Address - Fax:515-267-1471
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist