Provider Demographics
NPI:1790324440
Name:WHITTINGTON, CHASE ALEXANDER
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:ALEXANDER
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W 2ND AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-4467
Mailing Address - Country:US
Mailing Address - Phone:626-716-2144
Mailing Address - Fax:
Practice Address - Street 1:2700 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5117
Practice Address - Country:US
Practice Address - Phone:530-533-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist