Provider Demographics
NPI:1053528976
Name:CHESTERFIELD PHARMACY MEDICAL EQUIPMENT SUPPLIES INC
Entity type:Organization
Organization Name:CHESTERFIELD PHARMACY MEDICAL EQUIPMENT SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:206-838-6051
Mailing Address - Street 1:720 7TH AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1957
Mailing Address - Country:US
Mailing Address - Phone:206-838-6070
Mailing Address - Fax:206-838-9775
Practice Address - Street 1:720 7TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1957
Practice Address - Country:US
Practice Address - Phone:206-838-6070
Practice Address - Fax:206-838-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6026272Medicaid
WA6026272Medicaid