Provider Demographics
NPI:1538461538
Name:THANKACHAN, NITHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NITHA
Middle Name:
Last Name:THANKACHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3121
Mailing Address - Country:US
Mailing Address - Phone:917-544-0742
Mailing Address - Fax:
Practice Address - Street 1:6400 AMBOY ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3121
Practice Address - Country:US
Practice Address - Phone:917-544-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist