Provider Demographics
NPI:1689280786
Name:WINTERS, CHASE DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:DAVID
Last Name:WINTERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 N ROCK RD APT 2012
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1234
Mailing Address - Country:US
Mailing Address - Phone:620-778-3426
Mailing Address - Fax:
Practice Address - Street 1:3770 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2220
Practice Address - Country:US
Practice Address - Phone:316-686-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist