Provider Demographics
NPI:1831532548
Name:HERLYN, CHAD (RPH)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:HERLYN
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 1:12220 S 71 HWY
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1130
Mailing Address - Country:US
Mailing Address - Phone:816-777-2448
Mailing Address - Fax:816-777-2579
Practice Address - Street 1:12220 S 71 HWY
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1130
Practice Address - Country:US
Practice Address - Phone:816-777-2448
Practice Address - Fax:816-777-2579
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0436891835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist