Provider Demographics
NPI:1962095976
Name:PHELPS, CHAD W (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:W
Last Name:PHELPS
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 1:460 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-1402
Mailing Address - Country:US
Mailing Address - Phone:270-299-2333
Mailing Address - Fax:270-299-2334
Practice Address - Street 1:460 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1402
Practice Address - Country:US
Practice Address - Phone:270-299-2333
Practice Address - Fax:270-299-2334
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0011835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist