Provider Demographics
NPI:1134233240
Name:VANVACTER, CHANDRA RENEE (RPH)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:RENEE
Last Name:VANVACTER
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 1:675 FM 3264
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:TX
Mailing Address - Zip Code:76270-2332
Mailing Address - Country:US
Mailing Address - Phone:940-683-2449
Mailing Address - Fax:940-683-8059
Practice Address - Street 1:709 WW RAY CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-5023
Practice Address - Country:US
Practice Address - Phone:940-683-2950
Practice Address - Fax:940-683-8059
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40964OtherRPH