Basic Information
| Provider Information | |||||||||
| NPI: | 1861092140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAUVIN | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 300 KINGS FORT PKWY | ||||||||
| Address2: | |||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751423575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695957076 | ||||||||
| FaxNumber: | 4695957069 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 KINGS FORT PKWY | ||||||||
| Address2: | |||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751423575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695957076 | ||||||||
| FaxNumber: | 4695957069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 39134 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.