Provider Demographics
NPI:1063782290
Name:BELTON, CHAD WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WILLIAM
Last Name:BELTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12402 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1827
Mailing Address - Country:US
Mailing Address - Phone:913-626-4000
Mailing Address - Fax:
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-541-5550
Practice Address - Fax:913-541-5550
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15623183500000X
MO2013008811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist