Provider Demographics
NPI:1154020402
Name:CHARTWELL PHARMACY LLC
Entity type:Organization
Organization Name:CHARTWELL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-817-8620
Mailing Address - Street 1:608 13TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-6401
Mailing Address - Country:US
Mailing Address - Phone:712-314-2303
Mailing Address - Fax:712-224-4043
Practice Address - Street 1:608 13TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-6401
Practice Address - Country:US
Practice Address - Phone:712-314-2303
Practice Address - Fax:712-224-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy