Provider Demographics
NPI:1134443575
Name:BREWER, CHAD E (RPH)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:BREWER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 NILLES RD SUITE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-1618
Mailing Address - Country:US
Mailing Address - Phone:513-863-3350
Mailing Address - Fax:513-863-3916
Practice Address - Street 1:765 NILLES RD
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-9302
Practice Address - Country:US
Practice Address - Phone:513-863-3350
Practice Address - Fax:513-863-3916
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist