Provider Demographics
NPI:1154629764
Name:DAS, BIMAL CHANDRA (RPH)
Entity Type:Individual
Prefix:MR
First Name:BIMAL
Middle Name:CHANDRA
Last Name:DAS
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 1:7073 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4769
Mailing Address - Country:US
Mailing Address - Phone:410-200-4861
Mailing Address - Fax:
Practice Address - Street 1:1301 E STATE ST
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-2330
Practice Address - Country:US
Practice Address - Phone:410-896-9612
Practice Address - Fax:410-896-9617
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist