Provider Demographics
NPI:1780955856
Name:STOCKHAM, CHAD (RPH)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:STOCKHAM
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 1:259 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-4011
Mailing Address - Country:US
Mailing Address - Phone:740-886-7685
Mailing Address - Fax:740-886-1493
Practice Address - Street 1:259 STATE ST
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-4011
Practice Address - Country:US
Practice Address - Phone:740-886-7685
Practice Address - Fax:740-886-1493
Is Sole Proprietor?:No
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03220759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist