Healthcare Provider Details

I. General information

NPI: 1831429463
Provider Name (Legal Business Name): CHADANAPIS CHOTIDILOKE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 HILLSIDE RD
PELHAM NY
10803-2723
US

IV. Provider business mailing address

661 HILLSIDE RD
PELHAM NY
10803-2723
US

V. Phone/Fax

Practice location:
  • Phone: 914-738-2400
  • Fax: 914-738-7425
Mailing address:
  • Phone: 914-738-2400
  • Fax: 914-738-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: