MEDICARE: JUDY BEN CHENNAT PHARM D

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	183500000X	Pharmacist	17530	MD

General Provider Information

NPI Number	:	1831506427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY BEN CHENNAT PHARM D

Provider Business Mailing Address
First Line	:	1001 TWIN ARCH RD
Second Line	:	SUITE#18
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4138
Country	:	US
Telephone Number	:	301-829-0966
Fax Number	:	310-829-5213

Provider Business Practice Location Address
First Line	:	1001 TWIN ARCH RD
Second Line	:	SUITE#18
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4138
Country	:	US
Telephone Number	:	301-829-0966
Fax Number	:	310-829-5213

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/16/2014

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