Healthcare Provider Details

I. General information

NPI: 1427468339
Provider Name (Legal Business Name): NICHOLAS CHIMITRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E US HIGHWAY 30
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

611 E US HIGHWAY 30
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-650-3733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26013989A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26013989A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: