Provider Demographics
NPI:1740369420
Name:CHESAPEAKE PHARMACY SERVICES
Entity type:Organization
Organization Name:CHESAPEAKE PHARMACY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:HESTER, SR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:804-435-8588
Mailing Address - Street 1:101 HARRIS RD
Mailing Address - Street 2:PO BOX 1449
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-3880
Mailing Address - Country:US
Mailing Address - Phone:804-435-8588
Mailing Address - Fax:804-435-8543
Practice Address - Street 1:101 HARRIS RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3880
Practice Address - Country:US
Practice Address - Phone:804-435-8588
Practice Address - Fax:804-435-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003373333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8508666Medicaid
4830344OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1172610001Medicare ID - Type Unspecified