Provider Demographics
NPI:1336693332
Name:CHHUAN, BORADETTE EVELYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BORADETTE
Middle Name:EVELYN
Last Name:CHHUAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3124
Mailing Address - Country:US
Mailing Address - Phone:410-655-9890
Mailing Address - Fax:
Practice Address - Street 1:8302 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-3124
Practice Address - Country:US
Practice Address - Phone:410-655-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist