Provider Demographics
NPI:1952958373
Name:PENTECOST, CHAD ANDREW (RPH)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ANDREW
Last Name:PENTECOST
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 1:2150 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1217
Mailing Address - Country:US
Mailing Address - Phone:765-935-4650
Mailing Address - Fax:765-962-5927
Practice Address - Street 1:2150 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1217
Practice Address - Country:US
Practice Address - Phone:765-935-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020002A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist