Provider Demographics
NPI:1992856629
Name:CHESTERFIELD PHARMACY
Entity Type:Organization
Organization Name:CHESTERFIELD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DANIEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-323-0147
Mailing Address - Street 1:2301 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2957
Mailing Address - Country:US
Mailing Address - Phone:206-323-0147
Mailing Address - Fax:206-323-0368
Practice Address - Street 1:2301 E UNION ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2957
Practice Address - Country:US
Practice Address - Phone:206-323-0147
Practice Address - Fax:206-323-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6026272Medicaid