Provider Demographics
NPI:1639781289
Name:CHARD, NATHANIEL MARTIN (PHARMD(C), 2024)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:MARTIN
Last Name:CHARD
Suffix:
Gender:M
Credentials:PHARMD(C), 2024
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 WOODMAN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4486
Mailing Address - Country:US
Mailing Address - Phone:818-809-2228
Mailing Address - Fax:
Practice Address - Street 1:5750 WOODMAN AVE APT 2
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-4486
Practice Address - Country:US
Practice Address - Phone:818-809-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT47300390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program