Provider Demographics
NPI:1700486206
Name:HUNTER, CHASE MICHAEL
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:MICHAEL
Last Name:HUNTER
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 1:1718 N DESARC WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6904
Mailing Address - Country:US
Mailing Address - Phone:479-883-4723
Mailing Address - Fax:
Practice Address - Street 1:3510 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4931
Practice Address - Country:US
Practice Address - Phone:479-621-6470
Practice Address - Fax:479-621-6461
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist