Provider Demographics
NPI:1013497411
Name:CHLADEK, JOHN JAMES
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:CHLADEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 AIRPORT PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5998
Mailing Address - Country:US
Mailing Address - Phone:707-468-0171
Mailing Address - Fax:707-468-8505
Practice Address - Street 1:1155 AIRPORT PARK BLVD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5998
Practice Address - Country:US
Practice Address - Phone:707-468-0171
Practice Address - Fax:707-468-8505
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist