Provider Demographics
NPI:1558408666
Name:TRIVEDI, CHANDRAKANT L (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CHANDRAKANT
Middle Name:L
Last Name:TRIVEDI
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 1:4 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-6145
Mailing Address - Country:US
Mailing Address - Phone:631-348-7578
Mailing Address - Fax:
Practice Address - Street 1:48 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1415
Practice Address - Country:US
Practice Address - Phone:631-581-4285
Practice Address - Fax:631-581-4313
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352161835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support