Healthcare Provider Details

I. General information

NPI: 1710552773
Provider Name (Legal Business Name): CHANDRA SEKHAR PANCHUMARTHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7072 N CEDAR AVE
FRESNO CA
93720-3300
US

IV. Provider business mailing address

7072 N CEDAR AVE
FRESNO CA
93720-3300
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-8608
  • Fax: 559-472-3103
Mailing address:
  • Phone: 559-321-8608
  • Fax: 559-472-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number65850
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: