Healthcare Provider Details

I. General information

NPI: 1891659728
Provider Name (Legal Business Name): DISHA RAMESHBHAI CHAUDHARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 CARISBROOKE DR
MOUNT JULIET TN
37122-2440
US

IV. Provider business mailing address

2904 CARISBROOKE DR
MOUNT JULIET TN
37122-2440
US

V. Phone/Fax

Practice location:
  • Phone: 516-849-2382
  • Fax:
Mailing address:
  • Phone: 516-849-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073616
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: