Provider Demographics
NPI:1346640927
Name:THAKKAR, CHANDNI C
Entity Type:Individual
Prefix:
First Name:CHANDNI
Middle Name:C
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 S LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2290
Mailing Address - Country:US
Mailing Address - Phone:414-448-4001
Mailing Address - Fax:
Practice Address - Street 1:7800 S LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-2290
Practice Address - Country:US
Practice Address - Phone:414-448-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297975183500000X
WI17695-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist