Provider Demographics
NPI:1447928130
Name:KENNEDY-GALLEY, CHASE A (CPHT)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:A
Last Name:KENNEDY-GALLEY
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1756
Mailing Address - Country:US
Mailing Address - Phone:248-568-1992
Mailing Address - Fax:
Practice Address - Street 1:640 N MILFORD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1534
Practice Address - Country:US
Practice Address - Phone:248-676-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303021878183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician