Provider Demographics
NPI:1073912788
Name:CHAKDER, SUSHANTA (RPH)
Entity Type:Individual
Prefix:
First Name:SUSHANTA
Middle Name:
Last Name:CHAKDER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 NOLAN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3506
Mailing Address - Country:US
Mailing Address - Phone:301-217-9214
Mailing Address - Fax:
Practice Address - Street 1:10200 NOLAN DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3506
Practice Address - Country:US
Practice Address - Phone:301-217-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist