Healthcare Provider Details

I. General information

NPI: 1982968608
Provider Name (Legal Business Name): CHAKRA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 NORTH ST
GREENWICH CT
06831-2701
US

IV. Provider business mailing address

1043 NORTH ST
GREENWICH CT
06831-2701
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-2130
  • Fax: 203-864-9227
Mailing address:
  • Phone: 203-869-2130
  • Fax: 203-864-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPCY.0000741
License Number StateCT

VIII. Authorized Official

Name: SONALI COSTA
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 203-869-2130