Provider Demographics
NPI:1639628639
Name:BLACK, CHANDANI (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHANDANI
Middle Name:
Last Name:BLACK
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 1:5855 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1321
Mailing Address - Country:US
Mailing Address - Phone:954-735-1640
Mailing Address - Fax:
Practice Address - Street 1:5855 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1321
Practice Address - Country:US
Practice Address - Phone:954-735-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-02
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist