Provider Demographics
NPI:1932378007
Name:CHASE, MICHAEL RALPH (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RALPH
Last Name:CHASE
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 1:612 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-4605
Mailing Address - Country:US
Mailing Address - Phone:701-748-6281
Mailing Address - Fax:701-748-2637
Practice Address - Street 1:30 MAIN RD W
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545
Practice Address - Country:US
Practice Address - Phone:701-748-2312
Practice Address - Fax:701-748-2637
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND34701835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric