Provider Demographics
NPI:1114225265
Name:CHHUNCHHA, DIVYANG PRAHLADBHAI
Entity Type:Individual
Prefix:MR
First Name:DIVYANG
Middle Name:PRAHLADBHAI
Last Name:CHHUNCHHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 THE PLZ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2450
Mailing Address - Country:US
Mailing Address - Phone:704-531-5232
Mailing Address - Fax:704-531-5135
Practice Address - Street 1:6018 THE PLZ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-2450
Practice Address - Country:US
Practice Address - Phone:704-531-5232
Practice Address - Fax:704-531-5135
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-13
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist