Provider Demographics
NPI:1891395414
Name:JARRIEL, CHELSEA HOLLAND
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:HOLLAND
Last Name:JARRIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SANDALWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-7749
Mailing Address - Country:US
Mailing Address - Phone:912-245-5398
Mailing Address - Fax:
Practice Address - Street 1:2423 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-0930
Practice Address - Country:US
Practice Address - Phone:478-272-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist