Provider Demographics
NPI:1235387374
Name:CHIKOTI, VISHWANATHAM (RPH)
Entity Type:Individual
Prefix:
First Name:VISHWANATHAM
Middle Name:
Last Name:CHIKOTI
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 1:134-07 LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2354
Mailing Address - Country:US
Mailing Address - Phone:718-206-0716
Mailing Address - Fax:718-206-0578
Practice Address - Street 1:134-07 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2354
Practice Address - Country:US
Practice Address - Phone:718-206-0716
Practice Address - Fax:718-206-0578
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047825-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3335355OtherNABP
NY02680151Medicaid
5621460001Medicare NSC