Provider Demographics
NPI:1710666854
Name:CHAFFEE PHARMACY INC.
Entity Type:Organization
Organization Name:CHAFFEE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DDEDMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:479-551-2840
Mailing Address - Street 1:6210 MASSARD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-5042
Mailing Address - Country:US
Mailing Address - Phone:479-551-2840
Mailing Address - Fax:479-551-2492
Practice Address - Street 1:6210 MASSARD RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-5042
Practice Address - Country:US
Practice Address - Phone:479-551-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy