Provider Demographics
NPI:1427258789
Name:CHESTER, STAN (PD)
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:
Last Name:CHESTER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3714
Mailing Address - Country:US
Mailing Address - Phone:501-315-7700
Mailing Address - Fax:501-315-0077
Practice Address - Street 1:414 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3714
Practice Address - Country:US
Practice Address - Phone:501-315-7700
Practice Address - Fax:501-315-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD 06574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist