Provider Demographics
NPI:1780862797
Name:CHANEY, JOHN (RPH PIC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CHANEY
Suffix:
Gender:M
Credentials:RPH PIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40823
Mailing Address - Country:US
Mailing Address - Phone:606-589-0003
Mailing Address - Fax:606-589-0009
Practice Address - Street 1:1803 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-1840
Practice Address - Country:US
Practice Address - Phone:606-589-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist