Provider Demographics
NPI:1952648719
Name:LECLAIR, CHAD VERNON (DPH)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:VERNON
Last Name:LECLAIR
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 LONG HOLLOW PIKE
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3480
Mailing Address - Country:US
Mailing Address - Phone:615-851-8436
Mailing Address - Fax:615-851-8523
Practice Address - Street 1:460 LONG HOLLOW PIKE
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3480
Practice Address - Country:US
Practice Address - Phone:615-851-8436
Practice Address - Fax:615-851-8523
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist