Provider Demographics
NPI:1114652666
Name:OROSCO, CHANTAL MARINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:MARINA
Last Name:OROSCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHANTAL
Other - Middle Name:
Other - Last Name:OROSCO-LUEDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:872 CHERRY BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6239
Mailing Address - Country:US
Mailing Address - Phone:931-980-9662
Mailing Address - Fax:
Practice Address - Street 1:1954 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8038
Practice Address - Country:US
Practice Address - Phone:931-554-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist