Provider Demographics
NPI:1396544664
Name:FLETCHER, CHANTE (RPH)
Entity type:Individual
Prefix:
First Name:CHANTE
Middle Name:
Last Name:FLETCHER
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 1:201 PINCOURT LOOP
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-8716
Mailing Address - Country:US
Mailing Address - Phone:404-821-7124
Mailing Address - Fax:
Practice Address - Street 1:4080 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3643
Practice Address - Country:US
Practice Address - Phone:478-781-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist