Provider Demographics
NPI:1386927705
Name:SOSALLA, CHASE LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:LEE
Last Name:SOSALLA
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 1:750 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4829
Mailing Address - Country:US
Mailing Address - Phone:507-452-4076
Mailing Address - Fax:507-452-4085
Practice Address - Street 1:750 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4829
Practice Address - Country:US
Practice Address - Phone:507-452-4076
Practice Address - Fax:507-452-4085
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist