Provider Demographics
NPI:1578109617
Name:EAPPEN, CHINTU
Entity Type:Individual
Prefix:
First Name:CHINTU
Middle Name:
Last Name:EAPPEN
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 1:1422 HARTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5455
Mailing Address - Country:US
Mailing Address - Phone:248-495-7261
Mailing Address - Fax:
Practice Address - Street 1:2051 18 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3703
Practice Address - Country:US
Practice Address - Phone:586-930-0720
Practice Address - Fax:583-930-0725
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020350891835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist