Provider Demographics
NPI:1952034894
Name:ANGLIN, CHASE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:ANGLIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 POPPS FERRY RD APT G37
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2273
Mailing Address - Country:US
Mailing Address - Phone:601-270-5497
Mailing Address - Fax:
Practice Address - Street 1:12550 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-5609
Practice Address - Country:US
Practice Address - Phone:251-865-1429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225591835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS802515235OtherMS DRIVER'S LICENSE