Provider Demographics
NPI:1063702140
Name:CHANEY, BRIAN WARD (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WARD
Last Name:CHANEY
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 1:1672 COLDWATER XING
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-9658
Mailing Address - Country:US
Mailing Address - Phone:419-732-2734
Mailing Address - Fax:
Practice Address - Street 1:1672 COLDWATER XING
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:OH
Practice Address - Zip Code:43440-9658
Practice Address - Country:US
Practice Address - Phone:419-732-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03110261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist