Provider Demographics
NPI:1811998461
Name:CHESAPEAKE INFUSION INC.
Entity type:Organization
Organization Name:CHESAPEAKE INFUSION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-854-6532
Mailing Address - Street 1:6272 LEE VISTA BLVD
Mailing Address - Street 2:LEGAL DEPT.
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5148
Mailing Address - Country:US
Mailing Address - Phone:888-773-7376
Mailing Address - Fax:888-773-7386
Practice Address - Street 1:140 QUIGLEY BLVD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4104
Practice Address - Country:US
Practice Address - Phone:800-540-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA3-0000703333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS330689Medicaid
KY54003413Medicaid
PA1914645Medicaid
NJ0015431Medicaid
DE1000014390Medicaid
PA1914645Medicaid