Provider Demographics
NPI:1013272467
Name:WADSWORTH, CHASE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:
Last Name:WADSWORTH
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 1:24983 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-7689
Mailing Address - Country:US
Mailing Address - Phone:208-221-1012
Mailing Address - Fax:
Practice Address - Street 1:2500 BLAINE ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4461
Practice Address - Country:US
Practice Address - Phone:208-454-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCS19216183500000X
IDP6689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist