Provider Demographics
NPI:1568060515
Name:CHANDRASHEKAR, RANJANI
Entity Type:Individual
Prefix:
First Name:RANJANI
Middle Name:
Last Name:CHANDRASHEKAR
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 1:6663 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:MN
Mailing Address - Zip Code:55340-4444
Mailing Address - Country:US
Mailing Address - Phone:801-554-8677
Mailing Address - Fax:
Practice Address - Street 1:12195 SINGLETREE LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7921
Practice Address - Country:US
Practice Address - Phone:952-829-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist