Provider Demographics
NPI:1235413899
Name:CHAWAN, KUSUMAKUMARI S (RPH)
Entity Type:Individual
Prefix:
First Name:KUSUMAKUMARI
Middle Name:S
Last Name:CHAWAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 W CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5804
Mailing Address - Country:US
Mailing Address - Phone:317-580-0260
Mailing Address - Fax:
Practice Address - Street 1:873 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5804
Practice Address - Country:US
Practice Address - Phone:317-580-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018105A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist