Provider Demographics
NPI:1760098511
Name:CHAPPELLE'S APOTHECARY LLC
Entity Type:Organization
Organization Name:CHAPPELLE'S APOTHECARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-923-2789
Mailing Address - Street 1:5100 WHILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4151
Mailing Address - Country:US
Mailing Address - Phone:904-923-2789
Mailing Address - Fax:972-552-7864
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4136
Practice Address - Country:US
Practice Address - Phone:469-602-5078
Practice Address - Fax:972-552-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy