Provider Demographics
NPI:1811611056
Name:CHAPPELLE FIRM
Entity type:Organization
Organization Name:CHAPPELLE FIRM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-923-2789
Mailing Address - Street 1:5100 WHILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4151
Mailing Address - Country:US
Mailing Address - Phone:469-602-5078
Mailing Address - Fax:469-602-5028
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4136
Practice Address - Country:US
Practice Address - Phone:469-602-5078
Practice Address - Fax:469-602-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34460OtherPHARMACY LICENSE