Provider Demographics
NPI:1982927307
Name:CHAMBERS, WAYNE WILLIAM
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:WILLIAM
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-2268
Mailing Address - Country:US
Mailing Address - Phone:812-926-1861
Mailing Address - Fax:
Practice Address - Street 1:5750 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1602
Practice Address - Country:US
Practice Address - Phone:513-574-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist