Provider Demographics
NPI:1235954512
Name:CHAPMAN, MICAH ALEXANDER
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:ALEXANDER
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 BLACK OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-7466
Mailing Address - Country:US
Mailing Address - Phone:828-234-1099
Mailing Address - Fax:
Practice Address - Street 1:1395 W D ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3505
Practice Address - Country:US
Practice Address - Phone:336-651-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist