Provider Demographics
NPI:1467066571
Name:CHAMPANERIA, MITESH B (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:MITESH
Middle Name:B
Last Name:CHAMPANERIA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-3021
Mailing Address - Country:US
Mailing Address - Phone:931-431-4977
Mailing Address - Fax:931-431-0235
Practice Address - Street 1:2975 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3021
Practice Address - Country:US
Practice Address - Phone:931-431-4977
Practice Address - Fax:931-431-0235
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000040457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist