Provider Demographics
NPI:1114501277
Name:DAVIS, CHANDRA (CPHT)
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 NH ROUTE 123
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:NH
Mailing Address - Zip Code:03458-7118
Mailing Address - Country:US
Mailing Address - Phone:802-829-8850
Mailing Address - Fax:
Practice Address - Street 1:19 WILTON RD STE 1A
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1799
Practice Address - Country:US
Practice Address - Phone:603-924-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCHPT-125584183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician