Provider Demographics
NPI:1821384850
Name:CHAPP, JOLENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:
Last Name:CHAPP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15150 CEDAR AVE
Mailing Address - Street 2:T0643
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7056
Mailing Address - Country:US
Mailing Address - Phone:952-891-5515
Mailing Address - Fax:
Practice Address - Street 1:15150 CEDAR AVE
Practice Address - Street 2:T0643
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7056
Practice Address - Country:US
Practice Address - Phone:952-891-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118211183500000X
WI12861-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist