MEDICARE: DAVINDERJIT KAUR CHAHAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	5302034372	MI

General Provider Information

NPI Number	:	1427695287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVINDERJIT KAUR CHAHAL

Provider Business Mailing Address
First Line	:	51707 COLONIAL DR
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4319
Country	:	US
Telephone Number	:	586-219-8031
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 S LIVERNOIS RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6901
Country	:	US
Telephone Number	:	248-652-4700
Fax Number	:	248-652-1961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2019
Last Update Date	:	06/08/2026

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