Provider Demographics
NPI:1619309234
Name:CHADDERWALA, JAY HARIVADAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:HARIVADAN
Last Name:CHADDERWALA
Suffix:
Gender:M
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 1:21655 N LAKE PLEASANT PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7436
Mailing Address - Country:US
Mailing Address - Phone:623-537-4591
Mailing Address - Fax:
Practice Address - Street 1:21655 N LAKE PLEASANT PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7436
Practice Address - Country:US
Practice Address - Phone:623-537-4591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058001183500000X
AZS019910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist