Provider Demographics
NPI:1023090040
Name:CHASTAIN, MARGARET MARY (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 HAMMOCK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4876
Mailing Address - Country:US
Mailing Address - Phone:770-942-3209
Mailing Address - Fax:
Practice Address - Street 1:4609 HAMMOCK LAKE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4876
Practice Address - Country:US
Practice Address - Phone:770-942-3209
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist