Provider Demographics
NPI:1174110696
Name:MOONEY, CHAD STEVEN (PHARMD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:STEVEN
Last Name:MOONEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4414
Mailing Address - Country:US
Mailing Address - Phone:870-425-2221
Mailing Address - Fax:
Practice Address - Street 1:200 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4414
Practice Address - Country:US
Practice Address - Phone:870-425-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist