Provider Demographics
NPI:1508573999
Name:CHAUDHARI, MINAXI SHANKARBHAI
Entity Type:Individual
Prefix:
First Name:MINAXI
Middle Name:SHANKARBHAI
Last Name:CHAUDHARI
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 1:830 COTTONWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-3520
Mailing Address - Country:US
Mailing Address - Phone:712-823-8667
Mailing Address - Fax:
Practice Address - Street 1:4500 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4705
Practice Address - Country:US
Practice Address - Phone:712-274-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist