Provider Demographics
NPI:1609410315
Name:CHADA, JYOTHI RANI (PHARM D)
Entity Type:Individual
Prefix:
First Name:JYOTHI RANI
Middle Name:
Last Name:CHADA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ROBIN NEST DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8521
Mailing Address - Country:US
Mailing Address - Phone:407-920-9620
Mailing Address - Fax:
Practice Address - Street 1:5511 DEEP LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5239
Practice Address - Country:US
Practice Address - Phone:407-618-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist