Provider Demographics
NPI:1518154210
Name:CHANDA, GEORGE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:CHANDA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 THEATRE CTR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2405
Mailing Address - Country:US
Mailing Address - Phone:973-729-5000
Mailing Address - Fax:
Practice Address - Street 1:1 THEATRE CTR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2405
Practice Address - Country:US
Practice Address - Phone:973-729-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R100995700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist