Basic Information
| Provider Information | |||||||||
| NPI: | 1134335003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHESLEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | GAYLE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 DAVERTON RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253032405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045335198 | ||||||||
| FaxNumber: | 3047203218 | ||||||||
| Practice Location | |||||||||
| Address1: | 864 OAKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253142010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043432807 | ||||||||
| FaxNumber: | 3047203218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 4537 | WV | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.