Healthcare Provider Details

I. General information

NPI: 1649782129
Provider Name (Legal Business Name): CANDACE CHELSEA CHIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 BROADWAY
KINGSTON NY
12401-4626
US

IV. Provider business mailing address

33 FOREST AVE APT 3
ALBANY NY
12208-3034
US

V. Phone/Fax

Practice location:
  • Phone: 845-331-3131
  • Fax:
Mailing address:
  • Phone: 347-233-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: