Provider Demographics
NPI:1417260738
Name:CHACKO, BINDU RACHEL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BINDU
Middle Name:RACHEL
Last Name:CHACKO
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 1:901 ROUTE 110
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3906
Mailing Address - Country:US
Mailing Address - Phone:631-752-8980
Mailing Address - Fax:
Practice Address - Street 1:901 ROUTE 110
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3906
Practice Address - Country:US
Practice Address - Phone:631-752-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052282183500000X
PARP043431L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist