Provider Demographics
NPI:1659836526
Name:HONEST, CHANDANI
Entity Type:Individual
Prefix:
First Name:CHANDANI
Middle Name:
Last Name:HONEST
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 1:8101 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2502
Mailing Address - Country:US
Mailing Address - Phone:916-726-4466
Mailing Address - Fax:916-726-4505
Practice Address - Street 1:8101 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2502
Practice Address - Country:US
Practice Address - Phone:916-726-4466
Practice Address - Fax:916-726-4505
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty