Provider Demographics
NPI:1871702522
Name:CHANCY, TINA W (RPH)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:W
Last Name:CHANCY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-0486
Mailing Address - Country:US
Mailing Address - Phone:229-794-8543
Mailing Address - Fax:229-794-4092
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1121
Practice Address - Country:US
Practice Address - Phone:229-794-2750
Practice Address - Fax:229-794-4092
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist