Provider Demographics
NPI:1487712238
Name:CHASE, SANDRA LEE (BS, PHARMD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:CHASE
Suffix:
Gender:F
Credentials:BS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7889 ASPENWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9613
Mailing Address - Country:US
Mailing Address - Phone:616-682-0514
Mailing Address - Fax:616-774-7256
Practice Address - Street 1:1840 WEALTHY ST SE
Practice Address - Street 2:MC 416
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2921
Practice Address - Country:US
Practice Address - Phone:616-774-5264
Practice Address - Fax:616-774-7256
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist