Provider Demographics
NPI:1881939478
Name:CHAFFEE, ANTHONY DONALD (BS PHARM)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DONALD
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 MAGNOLIA PKWY
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-3087
Mailing Address - Country:US
Mailing Address - Phone:706-726-8669
Mailing Address - Fax:
Practice Address - Street 1:2006 MAGNOLIA PKWY
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3087
Practice Address - Country:US
Practice Address - Phone:706-726-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11102183500000X
GA15704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist