Provider Demographics
NPI:1962730150
Name:CHESTERFIELD PHARMACY
Entity type:Organization
Organization Name:CHESTERFIELD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGIALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-838-6050
Mailing Address - Street 1:703 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1965
Mailing Address - Country:US
Mailing Address - Phone:206-838-6050
Mailing Address - Fax:
Practice Address - Street 1:703 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1965
Practice Address - Country:US
Practice Address - Phone:206-838-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANO PHAR.CF.000574193336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy