Basic Information
| Provider Information | |||||||||
| NPI: | 1568971968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHI | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15705 BONDY LN | ||||||||
| Address2: | |||||||||
| City: | DARNESTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208782114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404260588 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1701 TWIN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | HALETHORPE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212273553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107375000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2017 | ||||||||
| LastUpdateDate: | 09/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 25309 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.