Healthcare Provider Details

I. General information

NPI: 1770917536
Provider Name (Legal Business Name): MARINA ELIZABETH CHAMAKALA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ROUTE 303
VALLEY COTTAGE NY
10989-5900
US

IV. Provider business mailing address

133 CAMPBELL AVE
TAPPAN NY
10983-2130
US

V. Phone/Fax

Practice location:
  • Phone: 845-268-4765
  • Fax:
Mailing address:
  • Phone: 845-598-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: