Provider Demographics
NPI:1679254452
Name:CHAHAL, MANJAP SINGH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MANJAP
Middle Name:SINGH
Last Name:CHAHAL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AMANDA CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1640
Mailing Address - Country:US
Mailing Address - Phone:731-803-6567
Mailing Address - Fax:
Practice Address - Street 1:384 OIL WELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7929
Practice Address - Country:US
Practice Address - Phone:731-664-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist