Provider Demographics
NPI:1942873302
Name:PICKERING, CHASE C (PHARMD, MBA, PMP)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:C
Last Name:PICKERING
Suffix:
Gender:M
Credentials:PHARMD, MBA, PMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 ALLISTER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-2460
Mailing Address - Country:US
Mailing Address - Phone:646-320-1068
Mailing Address - Fax:
Practice Address - Street 1:2919 ALLISTER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-2460
Practice Address - Country:US
Practice Address - Phone:646-320-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66527183500000X
IA22149183500000X
IL051295515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist